Diffuse Axonal Injury: Analysis of 100 Patients with Radiological Signs

Levi, Lion; Guilburd, Joseph N.; Lemberger, Anshel; Soustiel, Jean F.; Feinsod, Moshé

doi:10.1227/00006123-199009000-00015

Cited by 86 publications

(38 citation statements)

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“…So, brain MRI gradient echo imaging is currently known to be the most sensitive method of confirming the presence of small hemorrhagic lesions on the white matter, corpus callosum, and brain stem in diffuse axonal injury 9,10,15) . Numerous clinical prognostic factors in patients with severe head injuries have been studied, including initial GCS, abnormal motor response, hypothalamic injury sign, duration of loss of consciousness, initial pupil size, associated hypotension or hypoxia, age, and sex 1,6,12,13,16,18) . Hypoxia and hypotension have been known to be among the most important associated medical conditions with regard to outcome in severely injured patients 3,12,13,18) .…”

Section: Discussionmentioning

confidence: 99%

“…Numerous clinical prognostic factors in patients with severe head injuries have been studied, including initial GCS, abnormal motor response, hypothalamic injury sign, duration of loss of consciousness, initial pupil size, associated hypotension or hypoxia, age, and sex 1,6,12,13,16,18) . Hypoxia and hypotension have been known to be among the most important associated medical conditions with regard to outcome in severely injured patients 3,12,13,18) . Initial GCS in patients with head injuries strongly correlates with outcome, especially a GCS score below 5, which is associated with a poorer outcome [6][7][8]12,16) .…”

Section: Discussionmentioning

confidence: 99%

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Time to Recover Consciousness in Patients with Diffuse Axonal Injury : Assessment with Reference to Magnetic Resonance Grading

Park

Hur

Kwon

et al. 2009

J Korean Neurosurg Soc

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Objective : This study was conducted to investigate the correlation between the degrees of injury on brain magnetic resonance imaging (MRI) and the time interval to recovery of consciousness in patients with diffuse axonal injury. Methods : From January 2004 to December 2008, 25 patients with diffuse axonal injury were treated at our hospital. We retrospectively investigated the patients' medical records and radiological findings. We divided the patients into three groups according to the grade of MRI finding : grade I, small scattered lesions on the white matter of the cerebral hemisphere; grade II, focal lesions on the corpus callosum; and grade III, additional focal lesions on the brain stem. Result : Seven patients belonged to the grade I group; 10 to the grade II group; and 8 to the grade III group. The mean Glasgow Coma Scale (GCS) score of all patients at the time of admission was 7.28. Recovery of consciousness was observed in 23 of the 25 patients; the remaining two patients never regained consciousness. The time interval to recovery of consciousness (awake status) ranged from 1 day to 125 days (mean 22.1 days) : grade I group patients, within approximately 1 week (mean 3.7 days); grade II group patients, within approximately 2 weeks (mean 12.5 days); and grade III group patients, within approximately 2 months (mean 59.5 days). Conclusion : Our study results suggest a correlation between the mean time interval to recovery of consciousness in patients with diffuse axonal injuries and the degrees of brain injuries seen on MRI. Patients with grade I and II diffuse axonal injuries recovered consciousness within 2 weeks, while patients with grade III injuries required approximately 2 months.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Time to Recover Consciousness in Patients with Diffuse Axonal Injury : Assessment with Reference to Magnetic Resonance Grading

Park

Hur

Kwon

et al. 2009

J Korean Neurosurg Soc

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“…Neuroimaging techniques such as CT scanning capture only momentary snapshots of significant lesions, and lesions such as diffuse axonal injury (DAI) cannot be accurately visualized (Levi et al, 1990). MRI scanning has better sensitivity to diffuse brain damage, but is often unavailable and impractical to perform in physiologically unstable patients (Kesler, 2000).…”

mentioning

confidence: 99%

αII-Spectrin Breakdown Products (SBDPs): Diagnosis and Outcome in Severe Traumatic Brain Injury Patients

Mondello

Robicsek

Gabrielli

et al. 2010

Journal of Neurotrauma

189

142

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In this study we assessed the clinical utility of quantitative assessments of aII-spectrin breakdown products (SBDP145 produced by calpain, and SBDP120 produced by caspase-3) in cerebrospinal fluid (CSF) as markers of brain damage and outcome after severe traumatic brain injury (TBI). We analyzed 40 adult patients with severe TBI (Glasgow Coma Scale [GCS] score 8) who underwent ventriculostomy. Patients requiring CSF drainage for other medical reasons served as controls. CSF samples were taken at admission and every 6 h thereafter for a maximum of 7 days and assessed using novel quantitative fragment-specific ELISAs for SBDPs. Outcome was assessed using the 3-month Glasgow Outcome Scale. Mean CSF levels of SBDPs were significantly higher in TBI patients than in controls at all time points examined. Different temporal release patterns of CSF SBDP145 and SBDP120 were observed. SBDP145 provided accurate diagnoses at all time points examined, while SBDP120 release was more accurate 24 h after injury. Within 24 h after injury, SBDP145 CSF concentrations significantly correlated with GCS scores, while SBDP120 levels correlated with age. SBDP levels were significantly higher in patients who died than in those who survived. SBDP145 levels (>6 ng/mL) and SBDP120 levels (>17.55 ng/mL) strongly predicted death (odds ratio 5.9 for SBDP145, and 18.34 for SBDP120). The time course of SBDPs in nonsurvivors also differed from that of survivors. These results suggest that CSF SBDP levels can predict injury severity and mortality after severe TBI, and can be useful complements to clinical assessment.

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“…Isto pode ser explicado pela conjunção de aceleração e impacto no acidente de trânsito. Em 110 pacientes com LAD, diagnosticada por tomografia computadorizada, Levi et al observaram que a associação de contusão ou hematoma e LAD aumentava a morbidade de forma significativa 20 . Embora a CC seja lesão focal associada a boa evolução clínica, quando determinada por acidente de trânsito, teria pior prognóstico em consequência da associação frequente com LAD.…”

Section: Resultsunclassified

Contusão cerebral em vítimas fatais de acidente de trânsito: frequência e associação com outras lesões cranioencefálicas

Pittella

Gusmão

1999

Arq. Neuro-Psiquiatr.

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JOSÉ EYMARD HOMEM PITTELLA, SEBASTIÃO SILVA GUSMÃO RESUMO -Realizou-se análise morfológica, macro e microscópica, das lesões encefálicas de 120 vítimas fatais de acidente de trânsito. A contusão recente ocorreu em 67 pacientes (55,8%). As localizações mais frequentes foram a região orbitofrontal (27,8%) e a região polar do lobo temporal (19,8%). A contusão cerebral estava associada a fratura do crânio em 70,1% dos casos e a lesão axonal difusa em 89,5%, associação essa que pode ser explicada pela conjunção de aceleração e impacto no acidente de trânsito. A contusão antiga foi encontrada em seis pacientes (5,0%).PALAVRAS-CHAVE: trauma cranioencefálico, acidente de trânsito, contusão cerebral. Cerebral contusion in victims of fatal road traffic accident: frequency and association with other head injury lesionsABSTRACT -A morphological study, macro and microscopical, was made of brain lesions in 120 victims of fatal road traffic accidents. Contusions of the brain were identified in 67 (55.8%) of the patients. The contusions especially affected the orbital surfaces of the frontal lobes (27.8%) and the temporal poles (19.8%). The recent brain contusion was associated with a skull fracture in 70.1% of the cases and with a diffuse axonal injury in 89.5%. These can be explained by the association of contact and inertia from the road traffic accidents. Old contusions were identified in six patients (5.0%).

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Diffuse Axonal Injury: Analysis of 100 Patients with Radiological Signs

Cited by 86 publications

References 0 publications

Time to Recover Consciousness in Patients with Diffuse Axonal Injury : Assessment with Reference to Magnetic Resonance Grading

Time to Recover Consciousness in Patients with Diffuse Axonal Injury : Assessment with Reference to Magnetic Resonance Grading

αII-Spectrin Breakdown Products (SBDPs): Diagnosis and Outcome in Severe Traumatic Brain Injury Patients

Contusão cerebral em vítimas fatais de acidente de trânsito: frequência e associação com outras lesões cranioencefálicas

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