No abstract

No abstract

Glioma is the most common intra-axial brain tumor characterized by invasion into the surrounding white matter (WM) tracts. These tumors are usually diagnosed by conventional MRI, but this method is unable to describe the relationship between tumor and neighboring WM tracts. Diffusion tensor tractography (DTT) is a new imaging modality which can solve this problem. The current study evaluated the application of DTT imaging in the presurgical assessment of gliomas, and introduces this new modality and its importance to physicians and imaging centers in Iran. Ten patients with intra-axial brain tumor and suspicion of glioma underwent conventional brain MRI pulse sequences and DTT imaging between December 2011 and February 2013 with a 1.5 Tesla system using 64 independent diffusion encoding directions. Acquired images were assessed by the neuroradiologist and neurosurgeon. The treatment strategies were recognized and compared using data before and after the tractography. On the basis of DTT data, the treatment strategy changed from radiotherapy to the craniotomy in seven patients, and in one patient, the neurosurgeon preferred to avoid surgery. In one patient, the treatment technique did not change, and in the last one radiosurgery was replaced by craniotomy. As we can infer from this study, based on the tractography results, the treatment strategy may be changed, and the treatment technique could be devised more accurately and may lead to fewer postoperative neurological deficits and better outcomes.

Background:The Glasgow Coma Scale (GCS) is popular, simple, and reliable, and provides information about the level of consciousness in trauma patients. However, a systemic evaluation scale especially in patients with multiple traumas is so important. The revised Acute Physiology and Chronic Health Evaluation system type 2 (APACHE II) is a physiologically based system including physiological variables. This study compares the efficacy of the predicting power for mortality and functional outcome of GCS and APACHEII in patients with multiple traumas in intensive care unit.Methods:This study included the patients with head injury associated with systemic trauma admitted in the ICU of Shahid Rajaee Hospital in 2007 and 2008. Sensitivity, specificity and correct prediction of outcome by GCS and APACHE II were assessed and compared.Results:This study included 93 patients (79 males, 14 females; mean age 60.5; range 14 to 87 years) with head injury associated with systemic trauma in 2007 and 2008. Mortality increased in the elderly group. The mean survival score using APACHE II was 36.5 and death score was 67.4. These values using GCS were 10.3 and 6.8, respectively.Conclusion:For the assessment of mortality, the GCS score still provides simple, rapid and effective assessment in head injury patients, however, for the prediction of mortality in patients with multiple trauma APACHE II is superior to GCS since it includes multiple systemic parameters in these patients.

Although deterioration rarely occurs in patients with mild brain injury, those with coagulopathy, anticoagulant drug use, GCS of 13-14, increased age, midline shift, cerebral contusions, diffuse cerebral oedema and SDH were more prone to deterioration.