Pediatric brainstem hemorrhages after traumatic brain injury

Beier, Alexandra D; Dirks, Peter B.

doi:10.3171/2014.7.peds13376

Cited by 15 publications

(17 citation statements)

References 14 publications

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“…[12][13][14] Nevertheless, similar to previous reports, we have demonstrated that not all patients with DAI, including those with brainstem DAI, have an unfavorable outcome. 12,17,18 About 17% (95%CI 9-45) and 11% (95%CI 2-43) of our patients who had DAI in any brain regions and brainstem DAI, respectively, indeed turned out to have a favorable outcome at 18-months. As such, our results would suggest that clinicians should be prudent not to rely on the presence of DAI or brainstem DAI alone to prognosticate the outcome of their patients with severe TBI.…”

Section: Discussionmentioning

confidence: 70%

089 Prognostic significance of magnetic resonance imaging in patients with severe non-penetrating traumatic brain injury requiring decompressive craniectomy

Honeybul

Ambati

2018

J Neurol Neurosurg Psychiatry

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IntroductionDiffuse axonal injury (DAI) detected on magnetic resonance imaging (MRI) may be useful to predict outcome after traumatic brain injury (TBI).MethodsThis study compared the ability of the International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) prognostic model with DAI on MRI, to predict 18 months neurological outcome in 56 patients who had required a decompressive craniectomy after TBI.Of the 56 patients included in the study (19 scans occurred within 14 days; median time for all patients 24 days, interquartile range 14–42), 18 (32%) had evidence of DAI on the MRI scans. The presence of DAI on the MRI diffusion-weighted (DW), T2*-weighted-gradient echo and susceptibility-weighted (SWI) sequences was associated with an increased risk of unfavourable outcome at 18 months compared to those without DAI (44% vs. 17%, difference=27%, 95% confidence interval 2.4%–46.7%; p=0.032), particularly when brainstem was involved. However, neither the grading (I to IV) nor the number of brain regions with DAI was as good as the IMPACT model in discriminating between patients with unfavourable and favourable outcome (area under the receiver-operating-characteristic curve: 0.625 and 0.621 vs 0.918, respectively; p<0.001 for both comparisons). After adjusting for the IMPACT prognostic risks, DAI in different brain regions and the grading of DAI were also not independently associated with unfavourable outcome.ConclusionThe prognostic significance of DAI on MRI may, in part, be captured by the IMPACT prognostic model. More research is needed before MRI should be routinely used to prognosticate outcomes of patients with TBI requiring decompressive craniectomy.

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Section: Discussionmentioning

confidence: 70%

089 Prognostic significance of magnetic resonance imaging in patients with severe non-penetrating traumatic brain injury requiring decompressive craniectomy

Honeybul

Ambati

2018

J Neurol Neurosurg Psychiatry

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“…Recently the contribution of brain plasticity has been also invoked to explain the good recovery of 2 pediatric cases with traumatic brain injury. 1 In conclusion, DTH may represent an unusual complication in the management of trapped fourth ventricle. Endoscopic aqueductoplasty, whenever feasible, should be preferred to multiple shunting procedures to avoid the risk of differential pressure between the supratentorial and infratentorial compartment, which is the pathogenetic mechanism of this complication.…”

Section: Discussionmentioning

confidence: 91%

“…2 This results in secondary brainstem hemorrhages with a peculiar distribution in the rostral midbrain and in the ventral portion of the pons, presenting in a delayed fashion, that are termed Duret hemorrhages. 1,8,17 The pathogenesis of Duret hemorrhages has been hypothesized to consist of 2 mechanisms, stretching and disruption of small central perforating arteries or compression of small rostral draining veins, both ensuing from the abrupt descent of the brainstem against the basilar artery, which is relatively immobilized by the circle of Willis. 23 In the present case, the posthemorrhagic and postinfectious etiology of the hydrocephalus may have contributed to the arachnoidal scarring and relative immobilization of the basilar artery.…”

Section: Discussionmentioning

confidence: 99%

Descending transtentorial herniation, a rare complication of the treatment of trapped fourth ventricle: case report

Frassanito

Markogiannakis

Bonaventura

et al. 2015

PED

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Descending transtentorial herniation (DTH) is a complication of raised pressure in the supratentorial compartment, usually resulting from mass lesion of several etiologies. The authors report an exceptional case of DTH complicating the implant of a CSF shunting device in the trapped fourth ventricle of a 17-year-old boy in whom a second CSF shunting device had been implanted for neonatal posthemorrhagic and postinfectious hydrocephalus. The insidious clinical and radiological presentation of DTH, mimicking a malfunction of the supratentorial shunt, is documented. Ultimately, the treatment consisted of removal of the infratentorial shunt and endoscopic acqueductoplasty with stenting. The absence of supratentorial mass lesion and other described etiologies of DTH prompted the authors to speculate on the hydrodynamic pathogenesis of DTH in the present case.

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“…AEP wave III represents the cochlear nucleus which is located in the pontomedullary junction of the dorsolateral brainstem [ 35 ]. It is well known that brainstem lesions are associated with poor neurological outcome and fatality [ 36 ]. This finding could be reproduced in this study: Subjects with brain stem lesions on one or both sides showed a worse functional outcome from neurological early rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

May clinical neurophysiology help to predict the recovery of neurological early rehabilitation patients?

Rollnik

2015

BMC Neurol

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BackgroundSo far, the role of clinical neurophysiology in the prediction of outcome from neurological and neurosurgical early rehabilitation is unclear.MethodsClinical and neurophysiological data of a large sample of 803 early rehabilitation cases of the BDH-Clinic Hessisch Oldendorf in Northern Germany have been carefully reviewed. Most patients (43.5 %) were transferred to rehabilitation after stroke, mean age was 66.6 (15.5) years. Median somatosensory (SEP), auditory (AEP) and visual evoked potentials (VEP) along with EEG recordings took place within the first two weeks after admission. Length of stay (LOS) in early rehabilitation was 38.3 (37.2) days.ResultsAbsence of SEP on one or both sides was associated with poor outcome, χ2 = 12.98 (p = 0.005); only 12.5 % had a good outcome (defined as Barthel index, BI ≥50) when SEP were missing on both sides. In AEP, significantly longer bilateral latencies III were observed in the poor outcome group (p < 0.05). Flash VEP showed that patients in the poor outcome group had a significantly longer latency III on both sides (p < 0.05). The longer latency III, the smaller BI changes (BI discharge minus admission) were observed (latency III right r = −0.145, p < 0.01; left r = −0.206, p < 0.001). While about half of the patients with alpha EEG activity belonged to the good outcome group (80/159, 50.3 %), only 39/125 (31.2 %) with theta and 5/41 (12.2 %) with delta rhythm had a favourable outcome, χ2 = 24.2, p < 0.001.ConclusionsResults from this study suggest that loss of median SEP, prolongation of wave III in AEP and flash-VEP as well as theta or delta rhythms in EEG are associated with poor outcome from neurological early rehabilitation. Further studies on this topic are strongly encouraged.

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Pediatric brainstem hemorrhages after traumatic brain injury

Cited by 15 publications

References 14 publications

089 Prognostic significance of magnetic resonance imaging in patients with severe non-penetrating traumatic brain injury requiring decompressive craniectomy

089 Prognostic significance of magnetic resonance imaging in patients with severe non-penetrating traumatic brain injury requiring decompressive craniectomy

Descending transtentorial herniation, a rare complication of the treatment of trapped fourth ventricle: case report

May clinical neurophysiology help to predict the recovery of neurological early rehabilitation patients?

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