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Skandsen T, Kvistad KA, Solheim O, Strand IH, Folvik M, Vik A. Prevalence and impact of diffuse axonal injury in patients with moderate and severe head injury: a cohort study of early magnetic resonance imaging findings and 1-year outcome. J Neurosurg 2010; 113:556-63. [PMID: 19852541 DOI: 10.3171/2009.9.jns09626] [Citation(s) in RCA: 143] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT In this prospective cohort study the authors examined patients with moderate to severe head injuries using MR imaging in the early phase. The objective was to explore the occurrence of diffuse axonal injury (DAI) and determine whether DAI was related to level of consciousness and patient outcome. METHODS One hundred and fifty-nine patients (age range 5-65 years) with traumatic brain injury, who survived the acute phase, and who had a Glasgow Coma Scale (GCS) score of 3-13 were admitted between October 2004 and August 2008. Of these 159 patients, 106 were examined using MR imaging within 4 weeks postinjury. Patients were classified into 1 of 3 stages of DAI: Stage 1, in which lesions were confined to the lobar white matter; Stage 2, in which there were callosal lesions; and Stage 3, in which lesions occurred in the dorsolateral brainstem. The outcome measure used 12 months postinjury was the Glasgow Outcome Scale-Extended (GOSE). RESULTS Diffuse axonal injury was detected in 72% of the patients and a combination of DAI and contusions or hematomas was found in 50%. The GCS score was significantly lower in patients with "pure DAI" (median GCS Score 9) than in patients without DAI (median GCS Score 12; p < 0.001). The GCS score was related to outcome only in those patients with DAI (r = 0.47; p = 0.001). Patients with DAI had a median GOSE score of 7, and patients without DAI had a median GOSE score of 8 (p = 0.10). Outcome was better in patients with DAI Stage 1 (median GOSE Score 8) and DAI Stage 2 (median GOSE Score 7.5) than in patients with DAI Stage 3 (median GOSE Score 4; p < 0.001). Thus, in patients without any brainstem injury, there was no difference in good recovery between patients with DAI (67%) and patients without DAI (66%). CONCLUSIONS Diffuse axonal injury was found in almost three-quarters of the patients with moderate and severe head injury who survived the acute phase. Diffuse axonal injury influenced the level of consciousness, and only in patients with DAI was GCS score related to outcome. Finally, DAI was a negative prognostic sign only when located in the brainstem.
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Affiliation(s)
- Toril Skandsen
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
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Oni MB, Wilde EA, Bigler ED, McCauley SR, Wu TC, Yallampalli R, Chu Z, Li X, Hunter JV, Vasquez AC, Levin HS. Diffusion tensor imaging analysis of frontal lobes in pediatric traumatic brain injury. J Child Neurol 2010; 25:976-84. [PMID: 20332386 PMCID: PMC3227397 DOI: 10.1177/0883073809356034] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This study examined the use of diffusion tensor imaging in detecting white matter changes in the frontal lobes following pediatric traumatic brain injury. A total of 46 children (ages 8-16 years) with moderate to severe traumatic brain injury and 47 children with orthopedic injury underwent 1.5 Tesla magnetic resonance imaging (MRI) at 3 months postinjury. Conventional MRI studies were obtained along with diffusion tensor imaging. Diffusion tensor imaging metrics, including fractional anisotropy, apparent diffusion coefficient, and radial diffusivity, were compared between the groups. Significant group differences were identified, implicating frontal white matter alterations in the injury group that were predictive of later Glasgow Outcome Scale ratings; however, focal lesions were not related to the Glasgow Outcome Scale ratings. Injury severity was also significantly associated with diffusion tensor imaging metrics. Diffusion tensor imaging holds great promise as an index of white matter integrity in traumatic brain injury and as a potential biomarker reflective of outcome.
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Affiliation(s)
| | - Elisabeth A. Wilde
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas,Department of Radiology, Baylor College of Medicine, Houston, Texas,Department of Neurology, Baylor College of Medicine, Houston, Texas,E.B. Singleton Department of Diagnostic Imaging, Texas Children's Hospital, Houston, Texas
| | - Erin D. Bigler
- Department of Psychology, Brigham Young University, Provo, Utah,Department of Neuroscience, Brigham Young University, Provo, Utah,The Brain Institute, University of Utah, Salt Lake City, Utah
| | - Stephen R. McCauley
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas,Department of Pediatrics-Hematology and Oncology, Baylor College of Medicine, Houston, Texas
| | - Trevor C. Wu
- Department of Psychology, Brigham Young University, Provo, Utah
| | - Ragini Yallampalli
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Zili Chu
- Department of Radiology, Baylor College of Medicine, Houston, Texas,E.B. Singleton Department of Diagnostic Imaging, Texas Children's Hospital, Houston, Texas
| | - Xiaoqi Li
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Jill V. Hunter
- Department of Radiology, Baylor College of Medicine, Houston, Texas,E.B. Singleton Department of Diagnostic Imaging, Texas Children's Hospital, Houston, Texas
| | - Ana C. Vasquez
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Harvey S. Levin
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas
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