Lateral impact in closed head injury: A substantially increased risk for diffuse axonal injury—A preliminary study

Zwahlen, Roger A.; Labler, Ludwig; Trentz, O; Grätz, Klaus W.; Bachmann, Lucas M.

doi:10.1016/j.jcms.2007.01.006

Cited by 13 publications

(3 citation statements)

References 21 publications

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“…Our inclusion criterion was also guided by a previous study that has shown an association between facial fracture and DAI. 27 Inclusion of patients with facial trauma increased the number of mild TBI cases (71.9% in the present study vs 63.9% in 1 of the previous series 18 ). Although tSAH can result from both direct and indirect injuries, tSAH is more likely to result after severe rather than more mild cases of TBI, which we suspect has blurred the statistical significance of tSAH from indirect injuries in previous studies.…”

Section: Discussionmentioning

confidence: 38%

“…Since January 1, 2009, we have prospectively maintained a database of patients with a reported history of TBI, facial injury, or both (head trauma), who were admitted to the emergency department of Tohoku University Hospital, a major tertiary referral hospital in northeastern Japan. Because TBI of all severities is so frequently accompanied by facial injury, 4,27 and the degree of coexistence between these lesions sometimes cannot be accurately established on clinical grounds without imaging, we believed that it was appropriate to assess all of these patients together. Therefore, we have enrolled in our database 1189 consecutive patients with a reported history of closed head trauma who underwent a screening brain CT scan within 24 hours of injury between January 1, 2009, and December 31, 2013.…”

Section: Study Populationmentioning

confidence: 99%

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Traumatic midline subarachnoid hemorrhage on initial computed tomography as a marker of severe diffuse axonal injury

Mata‐Mbemba

Mugikura

Nakagawa³

et al. 2018

Journal of Neurosurgery

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OBJECTIVE The objective of this study was to test the hypothesis that midline (interhemispheric or perimesencephalic) traumatic subarachnoid hemorrhage (tSAH) on initial CT may implicate the same shearing mechanism that underlies severe diffuse axonal injury (DAI). METHODS The authors enrolled 270 consecutive patients (mean age [± SD] 43 ± 23.3 years) with a history of head trauma who had undergone initial CT within 24 hours and brain MRI within 30 days. Six initial CT findings, including intraventricular hemorrhage (IVH) and tSAH, were used as candidate predictors of DAI. The presence of tSAH was determined at the cerebral convexities, sylvian fissures, sylvian vallecula, cerebellar folia, interhemispheric fissure, and perimesencephalic cisterns. Following MRI, patients were divided into negative and positive DAI groups, and were assigned to a DAI stage: 1) stage 0, negative DAI; 2) stage 1, DAI in lobar white matter or cerebellum; 3) stage 2, DAI involving the corpus callosum; and 4) stage 3, DAI involving the brainstem. Glasgow Outcome Scale-Extended (GOSE) scores were obtained in 232 patients. RESULTS Of 270 patients, 77 (28.5%) had DAI; tSAH and IVH were independently associated with DAI (p < 0.05). Of tSAH locations, midline tSAH was independently associated with both overall DAI and DAI stage 2 or 3 (severe DAI; p < 0.05). The midline tSAH on initial CT had sensitivity of 60.8%, specificity of 81.7%, and positive and negative predictive values of 43.7% and 89.9%, respectively, for severe DAI. When adjusted for admission Glasgow Coma Score, the midline tSAH independently predicted poor GOSE score at both hospital discharge and after 6 months. CONCLUSIONS Midline tSAH could implicate the same shearing mechanism that underlies severe DAI, for which midline tSAH on initial CT is a probable surrogate.

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Section: Discussionmentioning

confidence: 38%

Section: Study Populationmentioning

confidence: 99%

Traumatic midline subarachnoid hemorrhage on initial computed tomography as a marker of severe diffuse axonal injury

Mata‐Mbemba

Mugikura

Nakagawa³

et al. 2018

Journal of Neurosurgery

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“…Both biomechanics and injury etiology may explain some variance in mTBI outcomes (Pertab et al, 2009). Head impact location (Viano, Casson, & Pellman, 2007) and neck strength (Zwahlen, Labler, Trentz, Grätz, & Bachmann, 2007) both influence the neurological outcomes of concussive events. As well, athletic populations may have unique experiences of mild head trauma compared with the general population, considering their physical fitness and desire for return-to-play (Belanger & Vanderploeg, 2005); however, although many meta-analyses have separately explored mixed-mechanism and sports-related mTBI, no existing reviews have quantitatively compared effect sizes derived from athletic and nonathletic samples.…”

Section: Discussionmentioning

confidence: 99%

The neuropsychological outcomes of concussion: A systematic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury.

2014

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Mild Traumatic Brain Injury (mTBI), also known as concussion, has become a growing public health concern, prevalent in both athletic and military settings. Many researchers have examined post-mTBI neuropsychological outcomes, leading to multiple meta-analyses amalgamating individual study results. Objective: Considering the plethora of meta-analytic findings, the next logical step stands as a systematic review of meta-analyses, effectively reporting key moderators that predict post-mTBI neuropsychological outcomes. Method: A systematic review of reviews yielded 11 meta-analyses meeting inclusion criteria (i.e., English-language systematic reviews/meta-analyses covering post-mTBI observational cognitive research on late adolescents/adults), with their findings qualitatively synthesized based on moderator variables (i.e., cognitive domain, time since injury, past head injury, participant characteristics, comparison group, assessment technique, and persistent symptoms). Results: The overall effect sizes ranged for both general (range: .07-.61) and sports-related mTBI (range: .40 -.81) and differed both between and within cognitive domains, with executive functions appearing most sensitive to multiple mTBI. Cognitive domains varied in recovery rates, but overall recovery occurred by 90 days postinjury for most individuals and by 7 days postinjury for athletes. Greater age/education and male gender produced smaller effects sizes, and high school athletes suffered the largest deficits post-mTBI. Controlgroup comparisons yielded larger effects than within-person designs, and assessment techniques had limited moderating effects. Conclusions: Overall, meta-analytic review quality remained low with few studies assessing publication or study quality bias. Meta-analyses consistently identified adverse acute mTBI-related effects and fairly rapid symptom resolution. Future meta-analyses should better operationally define cognitive constructs to produce more consistent effect estimates across domains. Keywords: mTBI, concussion, mild traumatic brain injury, cognition, neuropsychologySupplemental materials: http://dx.doi.org/10.1037/neu0000037.supp Mild Traumatic Brain Injury (mTBI), also known as concussion, stands as a prevalent neurotrauma within the general population , increasingly common in both athletic (Coronado, McGuire, Faul, Sugerman, & Pearson, 2012) and military settings (Iverson, Langlois, McCrea, & Kelly, 2009). The rates and consequences of mTBI have become progressively more publicized, both in sports (Moser, 2007) and in modern conflicts (Hayward, 2008). Highly prevalent in American football (Gessel, Fields, Collins, Dick, & Comstock, 2007), mTBI now represents a signature injury of the sport. Although its seriousness has been historically underestimated, repeated mTBIs among young athletes have been linked to significant neurodegeneration long after retiring from play (Gavett, Stern, & McKee, 2011;Guskiewicz et al., 2005;McKee et al., 2009). In 2011, Dave Duerson, a former American football safety, took his o...

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Traumatic Haemorrhage

Schmidt

Iacobellis

et al. 2022

Emergency Radiology of the Head and Spine

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Lateral impact in closed head injury: A substantially increased risk for diffuse axonal injury—A preliminary study

Cited by 13 publications

References 21 publications

Traumatic midline subarachnoid hemorrhage on initial computed tomography as a marker of severe diffuse axonal injury

Traumatic midline subarachnoid hemorrhage on initial computed tomography as a marker of severe diffuse axonal injury

The neuropsychological outcomes of concussion: A systematic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury.

Traumatic Haemorrhage

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