[Assessing and predicting recovery from a coma following traumatic brain injury: contribution of neuroradiological data]

[Epidemiological aspects and prognostic factors of severe traumatic brain injuries]

OBJECTIVE

To determine the severity factors in severe traumatic brain injuries.

METHODS

A prospective descriptive study of severe head injuries admitted to the emergency department at Ibn Tofail Hospital at the University Hospital of Marrakech over a period of six months from May to October 2015. The following data was collected: circumstances, clinical, biology, radiology, treatment and evolution.

RESULTS

One hundred and nineteen patients with severe traumatic brain injury were collected (101 males, 84,9%). The mean age was 37,73±15,7 years. Road accidents were the most common cause representing 84%. The median Glasgow coma scale (GCS) was 7±3. We noted 36 cases (30,3%) of anisocoria, 32 cases (26,9%) of bilateral mydriasis and 72 cases (60,5%) of hypoxia. Cerebral contusions (66,1%) and meningeal hemorrhage (66,6%) were the most frequent lesions on CT. Forty-seven patients (42%) had stage VI Marshall lesions. Twenty-four patients (20.1%) required a neurosurgical intervention, 12 extradural hematoma evacuations and 10 craniocerebral wounds. Mortality was 64.7% (77 deaths), the main cause was neurological (64,9%). In the latter group, we observed more frequently an older age (P=0.00001), a management delay (P=0.011), a low initial GCS (P=0.000001), a bilateral nonreactive mydriasis (P=0.0001), a hypoxia (P=0.0002), a subarachnoid hemorrhage (P=0.008), a high Marshall score (P=0.017) and an anemia (P=0.046).

CONCLUSION

Head trauma is a public health problem. The victims are young, and the sequelae are frequently disabling. Several parameters are associated with a poorer prognosis including age, neurological state and the initial delay in management.

[Neuroradiological investigations in mild brain injuries: state of the art and practical recommendations]

OBJECTIVES

To clarify the contribution of each technique of neuroradiological and nuclear medicine investigations after mild brain injuries. To analyze the pathophysiological mechanisms of the lesions. To update indications for imaging techniques in the short or long term management. To define the practical recommendations.

METHOD

The international databases were consulted for each neuroradiological technique; the most valuable articles were retained for study (PubMed, ).

RESULTS AND DISCUSSION

Standard skull X-rays are obsolete. Craniofacial (bony windows) and brain CT-scan (parenchymal windows) is the most efficient diagnosis tool in the acute phase because of its accessibility. Brain MRI is less accessible in the emergency setting but is feasible in some centers. It is the best choice in the first weeks following mild brain injury but may be normal. Taking into account the limitations of morphological imaging, functional imaging techniques (SPECT, fMRI, PET-scan) are necessary as they may show axonal damage or brain atrophy. There is however the problem of availability. SPECT is the most accessible. Spectro-MRI is promising. In spite of progress in neuroradiological investigation methods, the neuropsychological evaluation and multi-disciplinary treatment of these patients by a skilled team remains of utmost importance.

[Conventional and diffusion magnetic resonance imaging in the acute phase of severe traumatic brain injury]

Neuro-imaging is essential for the initial evaluation and subsequent control in the acute stage of severe head injury. In these indications tomodensitometry (TDM) has a pivotal role. Despite the well recognized contribution of magnetic resonance imaging (MRI) to the investigation of most of acute neurological pathologies, MRI is not still a routine procedure for the initial investigation of patients with acute head injury. The superiority of morphological and functional MRI on TDM in this indication is discussed.