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Angelova P, Kehayov I, Ordonez-Rubiano EG, Figueredo LF, Zlatareva D. Long-term Tractography Evaluation of Corpus Callosum Impairment After Severe Traumatic Brain Injury in Patients With Isolated Intraventricular Hemorrhage on Admission CT: Two Illustrative Cases and a Literature Review. Korean J Neurotrauma 2023; 19:249-257. [PMID: 37431372 PMCID: PMC10329887 DOI: 10.13004/kjnt.2023.19.e27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/20/2023] [Accepted: 04/08/2023] [Indexed: 07/12/2023] Open
Abstract
Severe traumatic brain injury (TBI) is often associated with diffuse axonal injury. Diffuse axonal injury affecting the corpus callosum may present with intraventricular hemorrhage on baseline computed tomography (CT) scan. Posttraumatic corpus callosum damage is a chronic condition that can be diagnosed over the long term using various magnetic resonance imaging (MRI) sequences. Here, we present two cases of severe survivors of TBI with isolated intraventricular hemorrhage detected on an initial CT scan. After acute trauma management, long-term follow-up was performed. Diffusion tensor imaging and subsequent tractography revealed a significant decrease in the fractional anisotropy values and the number of corpus callosum fibers compared with those in healthy control patients. This study presents a possible correlation between traumatic intraventricular hemorrhage on admission CT and long-term corpus callosum impairment detected on MRI in patients with severe head injury by presenting demonstrative cases and conducting a literature review.
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Affiliation(s)
- Polina Angelova
- Department of Neurosurgery, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Ivo Kehayov
- Department of Neurosurgery, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Edgar G. Ordonez-Rubiano
- Department of Neurosurgery, Hospital de San José – Sociedad de Cirugía de Bogotá, Fundación Universitaria de Ciencias de la Salud, Bogotá D.C., Colombia
| | - Luisa F. Figueredo
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Dora Zlatareva
- Department of Diagnostic Imaging, Medical University of Sofia, Sofia, Bulgaria
- Research Complex for Translational Neuroscience, Medical University of Plovdiv, Plovdiv, Bulgaria
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Zhang L, Badai J, Wang G, Ru X, Song W, You Y, He J, Huang S, Feng H, Chen R, Zhao Y, Chen Y. Discovering hematoma-stimulated circuits for secondary brain injury after intraventricular hemorrhage by spatial transcriptome analysis. Front Immunol 2023; 14:1123652. [PMID: 36825001 PMCID: PMC9941151 DOI: 10.3389/fimmu.2023.1123652] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/11/2023] [Indexed: 02/09/2023] Open
Abstract
Introduction Central nervous system (CNS) diseases, such as neurodegenerative disorders and brain diseases caused by acute injuries, are important, yet challenging to study due to disease lesion locations and other complexities. Methods Utilizing the powerful method of spatial transcriptome analysis together with novel algorithms we developed for the study, we report here for the first time a 3D trajectory map of gene expression changes in the brain following acute neural injury using a mouse model of intraventricular hemorrhage (IVH). IVH is a common and representative complication after various acute brain injuries with severe mortality and mobility implications. Results Our data identified three main 3D global pseudospace-time trajectory bundles that represent the main neural circuits from the lateral ventricle to the hippocampus and primary cortex affected by experimental IVH stimulation. Further analysis indicated a rapid response in the primary cortex, as well as a direct and integrated effect on the hippocampus after IVH stimulation. Discussion These results are informative for understanding the pathophysiological changes, including the spatial and temporal patterns of gene expression changes, in IVH patients after acute brain injury, strategizing more effective clinical management regimens, and developing novel bioinformatics strategies for the study of other CNS diseases. The algorithm strategies used in this study are searchable via a web service (www.combio-lezhang.online/3dstivh/home).
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Affiliation(s)
- Le Zhang
- College of Computer Science, Sichuan University, Chengdu, China,Innovation Center of Nursing Research, West China Hospital, Sichuan University, Chengdu, China
| | - Jiayidaer Badai
- College of Computer Science, Sichuan University, Chengdu, China
| | - Guan Wang
- College of Computer Science, Sichuan University, Chengdu, China,Innovation Center of Nursing Research, West China Hospital, Sichuan University, Chengdu, China
| | - Xufang Ru
- Chinese Academy of Sciences (CAS) Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China,Department of Neurosurgery and State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Army Medical University, Chongqing, China
| | - Wenkai Song
- College of Computer Science, Sichuan University, Chengdu, China
| | - Yujie You
- College of Computer Science, Sichuan University, Chengdu, China
| | - Jiaojiao He
- College of Computer Science, Sichuan University, Chengdu, China
| | - Suna Huang
- Department of Neurosurgery and State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Army Medical University, Chongqing, China
| | - Hua Feng
- Department of Neurosurgery and State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Army Medical University, Chongqing, China
| | - Runsheng Chen
- College of Computer Science, Sichuan University, Chengdu, China,Center for Big Data Research in Health, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China,West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Runsheng Chen, ; Yi Zhao, ; Yujie Chen, ;
| | - Yi Zhao
- College of Computer Science, Sichuan University, Chengdu, China,West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China,Research Center for Ubiquitous Computing Systems, Institute of Computing Technology, Chinese Academy of Sciences, Beijing, China,*Correspondence: Runsheng Chen, ; Yi Zhao, ; Yujie Chen, ;
| | - Yujie Chen
- Chinese Academy of Sciences (CAS) Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China,Department of Neurosurgery and State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Army Medical University, Chongqing, China,*Correspondence: Runsheng Chen, ; Yi Zhao, ; Yujie Chen, ;
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Li CY, Chuang CC, Chen CC, Tu PH, Wang YC, Yeap MC, Chen CT, Chang TW, Liu ZH. The Role of Intraventricular Hemorrhage in Traumatic Brain Injury: A Novel Scoring System. J Clin Med 2022; 11:jcm11082127. [PMID: 35456218 PMCID: PMC9028147 DOI: 10.3390/jcm11082127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/29/2022] [Accepted: 04/10/2022] [Indexed: 12/10/2022] Open
Abstract
Traumatic intraventricular hemorrhage (tIVH) is associated with increased mortality and disability in traumatic brain injury (TBI). However, the significance of tIVH itself remains unclear. Our goal is to assess whether tIVH affects in-hospital mortality and short-term functional outcomes. We retrospectively reviewed the records of 5048 patients with TBI during a 5-year period, and 149 tIVH patients were analyzed. Confounding was reduced using the inverse probability of treatment weighting (IPTW) based on propensity score. The association between IVH and outcomes was investigated using logistic regression in the IPTW-adjusted cohort. In our study, after adjustment for analysis, the in-hospital mortality rate (11.4% vs. 9.2%) and the poor functional outcome rate (37.9% vs.10.6%) were significantly higher in the tIVH group than in the non-tIVH group. Factors independently associated with outcomes were age ≥ 65 years, Glasgow Coma Scale (GCS) severity score, and the Graeb score. The Traumatic Graeb Score, a novel scoring system for predicting functional outcomes associated with tIVH, comprised the sum of the following components: GCS scores of 3 to 4 (=2 points), 5 to 12 (=1 point), 13 to 15 (=0 points); age ≥ 65 years, yes (=1 point), no (=0 points); Graeb score (0-12 points). A Traumatic Graeb Score ≥ 4 is an optimal cutoff value for poor short-term functional outcomes.
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Caliendo ET, Kim N, Edasery D, Askin G, Nowak S, Gerber LM, Baum KT, Blackwell LS, Koterba CH, Hoskinson KR, Kurowski BG, McLaughlin M, Tlustos SJ, Watson WD, Niogi SN, Suskauer SJ, Shah SA. Acute Imaging Findings Predict Recovery of Cognitive and Motor Function after Inpatient Rehabilitation for Pediatric Traumatic Brain Injury: A Pediatric Brain Injury Consortium Study. J Neurotrauma 2021; 38:1961-1968. [PMID: 33504256 PMCID: PMC8418527 DOI: 10.1089/neu.2020.7437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Traumatic brain injury (TBI) is a major cause of morbidity and mortality in children; survivors experience long-term cognitive and motor deficits. To date, studies predicting outcome following pediatric TBI have primarily focused on acute behavioral responses and proxy measures of injury severity; unsurprisingly, these measures explain very little of the variance following heterogenous injury. In adults, certain acute imaging biomarkers help predict cognitive and motor recovery following moderate to severe TBI. This multi-center, retrospective study, characterizes the day-of-injury computed tomographic (CT) reports of pediatric, adolescent, and young adult patients (2 months to 21 years old) who received inpatient rehabilitation services for TBI (n = 247). The study also determines the prognostic utility of CT findings for cognitive and motor outcomes assessed by the Pediatric Functional Independence Measure, converted to age-appropriate developmental functional quotient (DFQ), at discharge from rehabilitation. Subdural hematomas (66%), contusions (63%), and subarachnoid hemorrhages (59%) were the most common lesions; the majority of subjects had less severe Rotterdam CT scores (88%, ≤ 3). After controlling for age, gender, mechanism of injury, length of acute hospital stay, and admission DFQ in multivariate regression analyses, the highest Rotterdam score (β = -25.2, p < 0.01) and complete cisternal effacement (β = -19.4, p < 0.05) were associated with lower motor DFQ, and intraventricular hemorrhage was associated with lower motor (β = -3.7, p < 0.05) and cognitive DFQ (β = -4.9, p < 0.05). These results suggest that direct detection of intracranial injury provides valuable information to aid in prediction of recovery after pediatric TBI, and needs to be accounted for in future studies of prognosis and intervention.
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Affiliation(s)
| | - Nayoung Kim
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York, USA
- Blythedale Children's Hospital, Valhalla, New York, USA
| | - David Edasery
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Gulce Askin
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Sophie Nowak
- Blythedale Children's Hospital, Valhalla, New York, USA
| | - Linda M. Gerber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Katherine T. Baum
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Laura S. Blackwell
- Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Christine H. Koterba
- Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Kristen R. Hoskinson
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Brad G. Kurowski
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Departments of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Matthew McLaughlin
- Division of Pediatric Rehabilitation Medicine, Children's Mercy, Kansas City, Missouri, USA
- University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Sarah J. Tlustos
- Department of Rehabilitation, Children's Hospital Colorado and Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - William D. Watson
- Blythedale Children's Hospital, Valhalla, New York, USA
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Sumit N. Niogi
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Stacy J. Suskauer
- Kennedy Krieger Institute, Baltimore, Maryland, USA
- Departments of Physical Medicine & Rehabilitation and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sudhin A. Shah
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York, USA
- Blythedale Children's Hospital, Valhalla, New York, USA
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Guarnizo A, Chung HS, Chakraborty S. Subcallosal haemorrhage as a sign of diffuse axonal injury in patients with traumatic brain injury. Clin Radiol 2020; 76:237.e15-237.e21. [PMID: 33160606 DOI: 10.1016/j.crad.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/02/2020] [Indexed: 11/17/2022]
Abstract
AIM To identify the relationship between subcallosal haemorrhage and diffuse axonal injury (DAI) grading. MATERIALS AND METHODS Computed tomography (CT) and magnetic resonance imaging (MRI) images of all patients with traumatic brain injury over the past 5 years were reviewed. Subcallosal haemorrhage was defined as the presence of haemorrhage on admission CT underneath the corpus callosum. Grading of DAI was performed using MRI or CT exclusive of subcallosal haemorrhage status. The association of demographic factors, mechanism of injury, Glasgow Coma Scale (GCS) on admission, and positive subcallosal haemorrhage status with the presence of moderate-severe DAI was assessed. Receiver operating characteristic (ROC) curve analysis was used to evaluate the performance of subcallosal haemorrhage status in predicting DAI severity. Median modified Rankin Scale (mRS) scores were compared between subcallosal haemorrhage positive and negative cases. RESULTS The images of 1,150 patients were reviewed with 301 patients showing DAI. Of those, 64 patients (21.2%) and 237 patients (78.7%) were positive and negative for subcallosal haemorrhage, respectively. Isolated subcallosal haemorrhage was noted in 15 patients (23.4%). A subcallosal haemorrhage positive status (OR=5.16, p < 0.001) was statistically significantly associated with moderate-severe DAI. The ROC curve for predicting moderate-severe DAI with subcallosal haemorrhage status showed an area under the curve of 0.625 (95% confidence interval [CI]: 0.561-0.688, p < 0.001). The median mRS score was significantly higher (p < 0.001) in the subcallosal haemorrhage positive group (median 4.5, interquartile range [IQR] 2-6) versus the negative group (median 2, IQR 2-3). Isolated subcallosal haemorrhage group showed moderate-severe DAI in 80% (12/15) of cases. CONCLUSION Subcallosal haemorrhage is a highly specific radiographic predictor of moderate-severe DAI (grade 2-3).
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Affiliation(s)
- A Guarnizo
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada
| | - H S Chung
- Faculty of Medicine, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada
| | - S Chakraborty
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada.
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Figueira Rodrigues Vieira G, Guedes Correa JF. Early computed tomography for acute post-traumatic diffuse axonal injury: a systematic review. Neuroradiology 2020; 62:653-660. [PMID: 32130462 PMCID: PMC7222974 DOI: 10.1007/s00234-020-02383-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
Purpose Diffuse axonal injury (DAI) is the rupture of multiple axons due to acceleration and deceleration forces during a closed head injury. Most traumatic brain injuries (TBI) have some degree of DAI, especially severe TBI. Computed tomography (CT) remains the first imaging test performed in the acute phase of TBI, but has low sensitivity for detecting DAI, since DAI is a cellular lesion. The aim of this study is to search in the literature for CT signs, in the first 24 h after TBI, that may help to differentiate patients in groups with a better versus worst prognosis. Methods We searched for primary scientific articles in the PubMed database, in English, indexed since January 1st, 2000. Results Five articles were selected for review. In the DAI group, traffic accidents accounted 70% of the cases, 79% were male, and the mean age was 41 years. There was an association between DAI and intraventricular hemorrhage (IVH) and traumatic subarachnoid hemorrhage (tSAH); an association between the IVH grade and number of corpus callosum lesions; and an association between blood in the interpeduncular cisterns (IPC) and brainstem lesions. Conclusion In closed TBI with no tSAH, severe DAI is unlikely. Similarly, in the absence of IVH, any DAI is unlikely. If there is IVH, patients generally are clinically worse; and the more ventricles affected, the worse the prognosis.
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Affiliation(s)
- Giovana Figueira Rodrigues Vieira
- Department of Neurosurgery, Gaffrée e Guinle University Hospital, School of Medicine, Federal University of Rio de Janeiro State, 775 Mariz e Barros Street, Rio de Janeiro, RJ, Brazil.
| | - José Fernando Guedes Correa
- Department of Neurosurgery, Gaffrée e Guinle University Hospital, School of Medicine, Federal University of Rio de Janeiro State, 775 Mariz e Barros Street, Rio de Janeiro, RJ, Brazil
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7
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Mata-Mbemba D, Mugikura S, Nakagawa A, Murata T, Ishii K, Kushimoto S, Tominaga T, Takahashi S, Takase K. Traumatic midline subarachnoid hemorrhage on initial computed tomography as a marker of severe diffuse axonal injury. J Neurosurg 2018; 129:1317-1324. [PMID: 29303451 DOI: 10.3171/2017.6.jns17466] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/19/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe 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).METHODSThe 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.RESULTSOf 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.CONCLUSIONSMidline 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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Affiliation(s)
| | | | | | | | - Kiyoshi Ishii
- 3Department of Radiology, Sendai Kousei Hospital, Sendai, Japan
| | - Shigeki Kushimoto
- 4Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine; and
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Diffuse axonal injury (DAI) in moderate to severe head injured patients: Pure DAI vs. non-pure DAI. Clin Neurol Neurosurg 2018; 171:116-123. [PMID: 29909182 DOI: 10.1016/j.clineuro.2018.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/01/2018] [Accepted: 06/09/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Diffuse axonal injury (DAI) is known to be associated with poor outcome. DAI often associates with other intracranial injuries but their distinct features have not been established. In this retrospective cohort study, we compared clinical outcomes between pure and non-pure DAI patients. PATIENTS AND METHODS Total of 1047 traumatic brain injury (TBI) patients visited our institute between 2011 and 2017. Age ranged between 15-85 years old and Glasgow coma scale (GCS) score less than 13 were included. DAI was diagnosed in 45 patients using CT and MRI and their clinical features and outcomes were compared depending on their associated cranial injury; 20 patients without evidence of associated injury (Pure DAI group) and other 25 patients with associated injury (Non-pure DAI group). DAI stage was adopted using Gentry, L.R. CLASSIFICATION Glasgow outcome scale (GOS) was measured at least 6 months after trauma to evaluate their functional outcome. RESULTS The mean age and follow-up period were 45.36 years and 15.09 months, respectively. There were no significant differences between pure and non-pure DAI groups regarding demographic data and clinical findings on their admission. Logistic regression model was used to examine the association between GOS and clinical factors. In this analysis, pure DAI was no significantly different to non-pure DAI (p = 0.607). However, DAI Stage, transfusion, and hypotension on admission were strongly related to poor outcome. Stage III showed sevenfold higher risk when compared to Stage I (p = 0.010). The risk was also high when Stage III was compare to Stage I and II (p = 0.002). Interestingly, no significant difference was observed between Stage I and II (p = 0.847). CONCLUSIONS Unfavorable outcome was observed in 14 patients (31.11%) which was lower than we expected. Interestingly, non-pure DAI was no worse than pure DAI on their functional outcome. However, DAI Stage III was independently associated with poor outcome when compared to Stage I or I and II. Finally, we concluded that Stage II is clinically more related to Stage I, rather than Stage III.
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Shibahashi K, Sugiyama K, Okura Y, Hoda H, Hamabe Y. Intraventricular Hemorrhage After Head Injury: A Multicenter, Retrospective, Cohort Study. World Neurosurg 2018. [PMID: 29530690 DOI: 10.1016/j.wneu.2018.02.183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Data on traumatic intraventricular hemorrhage (IVH) are currently limited, and therefore, the condition is not fully understood. The aim of this study was to determine the epidemiology of traumatic IVH and its effects on outcome in patients with blunt head trauma. METHODS AND MATERIALS Using a nationwide trauma registry-the Japan Trauma Data Bank, we identified patients who underwent head computed tomography (CT) after blunt head trauma and had intracranial injuries between 2004 and 2015. The endpoint was in-hospital mortality. We compared patients with IVH and without IVH and adjusted for potential confounders using a multivariate logistic regression model. RESULTS A total of 236,698 patients were registered in the database. Of the 139,058 patients who underwent head CT after blunt trauma, 906 (0.7%) had traumatic IVH. Among the 53,618 patients who were eligible for analysis, 871 had IVH. Traumatic IVH was associated with the occurrence of traffic accidents that caused trauma and severe injuries. Mortality was significantly higher in patients with IVH than in those without IVH (33.5% vs. 18.5%; P < 0.001); however, the difference was not significant after adjusting for confounding factors, with an adjusted odds ratio of 1.13 (95% confidence interval: 0.91-1.40). CONCLUSIONS Traumatic IVH is associated with a high mortality. However, the outcome in patients with traumatic IVH was worse than that in patients without IVH, which could be a result of factors associated with IVH rather than of IVH alone.
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Affiliation(s)
- Keita Shibahashi
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
| | - Kazuhiro Sugiyama
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Yoshihiro Okura
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Hidenori Hoda
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Yuichi Hamabe
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
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Abstract
Traumatic brain injury remains a major cause of morbidity and mortality throughout the world, affecting young and old alike. Pathologic data have been developed through observations of human autopsies and developing animal models to investigate mechanisms, although animal models do not represent the polypathology of human brain injury and there are likely to be significant differences in the anatomic basis of injury and cellular responses between species. Traumatic brain injury can be defined pathologically as either focal or diffuse, and can be considered to be either primary, directly related to the force associated with the neurotrauma, or secondary, developing as a downstream consequence of the neurotrauma. While neuropathology has traditionally focused on severe head injury, there is increasing recognition of the long-term consequences of traumatic brain injury, particularly repetitive mild traumatic brain injury, and a possible long-term association with chronic traumatic encephalopathy.
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Affiliation(s)
- Colin Smith
- Department of Neuropathology, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom.
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11
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Diffuse Axonal Injury and Oxidative Stress: A Comprehensive Review. Int J Mol Sci 2017; 18:ijms18122600. [PMID: 29207487 PMCID: PMC5751203 DOI: 10.3390/ijms18122600] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 11/17/2017] [Accepted: 11/28/2017] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) is one of the world’s leading causes of morbidity and mortality among young individuals. TBI applies powerful rotational and translational forces to the brain parenchyma, which results in a traumatic diffuse axonal injury (DAI) responsible for brain swelling and neuronal death. Following TBI, axonal degeneration has been identified as a progressive process that starts with disrupted axonal transport causing axonal swelling, followed by secondary axonal disconnection and Wallerian degeneration. These modifications in the axonal cytoskeleton interrupt the axoplasmic transport mechanisms, causing the gradual gathering of transport products so as to generate axonal swellings and modifications in neuronal homeostasis. Oxidative stress with consequent impairment of endogenous antioxidant defense mechanisms plays a significant role in the secondary events leading to neuronal death. Studies support the role of an altered axonal calcium homeostasis as a mechanism in the secondary damage of axon, and suggest that calcium channel blocker can alleviate the secondary damage, as well as other mechanisms implied in the secondary injury, and could be targeted as a candidate for therapeutic approaches. Reactive oxygen species (ROS)-mediated axonal degeneration is mainly caused by extracellular Ca2+. Increases in the defense mechanisms through the use of exogenous antioxidants may be neuroprotective, particularly if they are given within the neuroprotective time window. A promising potential therapeutic target for DAI is to directly address mitochondria-related injury or to modulate energetic axonal energy failure.
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Lolli V, Pezzullo M, Delpierre I, Sadeghi N. MDCT imaging of traumatic brain injury. Br J Radiol 2016; 89:20150849. [PMID: 26607650 PMCID: PMC4985461 DOI: 10.1259/bjr.20150849] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/18/2015] [Accepted: 11/23/2015] [Indexed: 01/24/2023] Open
Abstract
The aim of emergency imaging is to detect treatable lesions before secondary neurological damage occurs. CT plays a primary role in the acute setting of head trauma, allowing accurate detection of lesions requiring immediate neurosurgical treatment. CT is also accurate in detecting secondary injuries and is therefore essential in follow-up. This review discusses the main characteristics of primary and secondary brain injuries.
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Affiliation(s)
- Valentina Lolli
- Radiology Department, Erasmus University Hospital, Brussels, Belgium
| | - Martina Pezzullo
- Radiology Department, Erasmus University Hospital, Brussels, Belgium
| | | | - Niloufar Sadeghi
- Radiology Department, Erasmus University Hospital, Brussels, Belgium
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Yokobori S, Yamaguchi M, Igarashi Y, Hironaka K, Onda H, Kuwamoto K, Araki T, Fuse A, Yokota H. Outcome and Refractory Factor of Intensive Treatment for Geriatric Traumatic Brain Injury: Analysis of 1165 Cases Registered in the Japan Neurotrauma Data Bank. World Neurosurg 2015; 86:127-133.e1. [PMID: 26459712 DOI: 10.1016/j.wneu.2015.09.105] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 09/22/2015] [Accepted: 09/23/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE With the increase in the aged population, geriatric traumatic brain injury (gTBI) is also rapidly increasing in Japan. There is thus a need to review the effect of intensive treatments for gTBIs. The aim of this study was 1) to assess how intensive treatments influenced patient outcome and 2) to identify the refractory factor against these intensive treatments in gTBI, from the Japan Neurotrauma Data Bank (JNTDB). METHODS Of all 3194 patients in the JNTDB, 1165 (≥ 65 years old) with severe gTBIs were enrolled in this study. The clinical features and their outcomes based on the Glasgow Outcome Scale on discharge and 6 months after injury were compared. RESULTS Intensive treatments were administered to 71.4% of all patients with severe gTBI showing a significant increase over 15 years. Accordingly, mortality decreased significantly (from 62.7% to 51.1%, P = 0.001). On the other hand, severely disabled dependent survivors, who need daily help from others for living, increased accordingly (from 63.2% to 68.4%). The existence of intraventricular hemorrhage (IVH) rather than the patient's age was identified as the strongest refractory factor (odds ratio, 5.762; 95% confidence interval, 1.317-25.216) against intensive treatment. CONCLUSIONS This study clarified that 1) intensive treatments are associated with higher survival rates (however, they also increase the incidence of severely disabled survivors) and 2) the strongest refractory factor for intensive treatment in cases of severe gTBI was not age but the existence of IVH. These results warrant further establishment of a seamless strategy for both the acute and the chronic phase of gTBI.
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Affiliation(s)
- Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
| | - Masahiro Yamaguchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Kohei Hironaka
- Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
| | - Hidetaka Onda
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Kentaro Kuwamoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Takashi Araki
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Akira Fuse
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
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15
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Buttram SDW, Garcia-Filion P, Miller J, Youssfi M, Brown SD, Dalton HJ, Adelson PD. Computed tomography vs magnetic resonance imaging for identifying acute lesions in pediatric traumatic brain injury. Hosp Pediatr 2015; 5:79-84. [PMID: 25646200 DOI: 10.1542/hpeds.2014-0094] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Pediatric traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children. Computed tomography (CT) is the modality of choice to screen for brain injuries. MRI may provide more clinically relevant information. The purpose of this study was to compare lesion detection between CT and MRI after TBI. METHODS Retrospective cohort of children (0-21 years) with TBI between 2008 and 2010 at a Level 1 pediatric trauma center with a head CT scan on day of injury and a brain MRI scan within 2 weeks of injury. Agreement between CT and MRI was determined by κ statistic and stratified by injury mechanism. RESULTS One hundred five children were studied. Of these, 78% had mild TBI. The MRI scan was obtained a median of 1 day (interquartile range, 1-2) after CT. Overall, CT and MRI demonstrated poor agreement (κ=-0.083; P=.18). MRI detected a greater number of intraparenchymal lesions (n=36; 34%) compared with CT (n=16; 15%) (P<.001). Among patients with abusive head trauma, MRI detected intraparenchymal lesions in 16 (43%), compared with only 4 (11%) lesions with CT (P=.03). Of 8 subjects with a normal CT scan, 6 out of 8 had abnormal lesions on MRI. CONCLUSIONS Compared with CT, MRI identified significantly more intraparenchymal lesions in pediatric TBI, particularly in children with abusive head trauma. The prognostic value of identification of intraparenchymal lesions by MRI is unknown but warrants additional inquiry. Risks and benefits from early MRI (including sedation, time, and lack of radiation exposure) compared with CT should be weighed by clinicians.
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Affiliation(s)
- Sandra D W Buttram
- Divisions of Critical Care Medicine, Department of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Arizona
| | - Pamela Garcia-Filion
- Department of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Arizona Trauma, Phoenix Children's Hospital, Phoenix, Arizona
| | - Jeffrey Miller
- Department of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Arizona Radiology and
| | - Mostafa Youssfi
- Department of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Arizona Radiology and
| | - S Danielle Brown
- Division of Neurosurgery, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona; and
| | - Heidi J Dalton
- Divisions of Critical Care Medicine, Department of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Arizona
| | - P David Adelson
- Department of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, Arizona Division of Neurosurgery, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona; and
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Mata-Mbemba D, Mugikura S, Nakagawa A, Murata T, Kato Y, Tatewaki Y, Li L, Takase K, Ishii K, Kushimoto S, Tominaga T, Takahashi S. Intraventricular hemorrhage on initial computed tomography as marker of diffuse axonal injury after traumatic brain injury. J Neurotrauma 2014; 32:359-65. [PMID: 25026366 DOI: 10.1089/neu.2014.3453] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Intraventricular hemorrhage (IVH) on initial computed tomography (CT) was reported to predict lesions of diffuse axonal injury (DAI) in the corpus callosum (CC) on subsequent magnetic resonance imaging (MRI). We aimed to examine the relationship between initial CT findings and DAI lesions detected on MRI as well as the relationship between the severity of IVH (IVH score) and severity of DAI (DAI staging). A consecutive 140 patients with traumatic brain injury (TBI) who underwent MRI within 30 days after onset were revisited. We reviewed their initial CT for the following six findings: Status of basal cistern, status of mid-line shift, epidural hematoma, IVH, subarachnoid hemorrhage, and volume of hemorrhagic mass and IVH score were assigned in each patient. Based on MRI findings, patients were divided into DAI and non-DAI groups and were assigned a DAI staging. Then, to confirm that the IVH on initial CT predicts DAI lesions on MRI, we used multi-variate analysis of the six CT findings, including IVH, and examined the relationship between IVH score and DAI staging. The IVH detected on CT was the only predictor of DAI (p=0.0139). The IVH score and DAI staging showed significant positive correlation (p<0.0003). IVH score in DAI stage 3 (with DAI involving the brain stem; p=0.0025) or stage 2 (with DAI involving CC; p=0.0042) was significantly higher than that of DAI stage 0 (no DAI lesions). In conclusion, IVH on initial CT is the only marker of DAI on subsequent MRI, specifically severe DAI (stage 2 or 3).
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Affiliation(s)
- Daddy Mata-Mbemba
- 1 Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine , Sendai, Japan
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Matsukawa H, Shinoda M, Fujii M, Takahashi O, Murakata A, Yamamoto D. Acute alcohol intoxication, diffuse axonal injury and intraventricular bleeding in patients with isolated blunt traumatic brain injury. Brain Inj 2013; 27:1409-14. [PMID: 24102331 DOI: 10.3109/02699052.2013.823655] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The influence of blood alcohol level (BAL) on outcome remains unclear. This study investigated the relationships between BAL, type and number of diffuse axonal injury (DAI), intraventricular bleeding (IVB) and 6-month outcome. METHODS This study reviewed 419 patients with isolated blunt traumatic brain injury. First, it compared clinical and radiological characteristics between patients with good recovery and disability. Second, it compared BAL among DAI lesions. Third, it evaluated the correlation between the BAL and severity of IVB, number of DAI and corpus callosum injury lesions. RESULTS Regardless of BAL, older age, male gender, severe Glasgow Coma Scale score (<9), abnormal pupil, IVB and lesion on genu of corpus callosum were significantly related to disability. There were no significant differences between the BAL and lesions of DAI. Simple regression analysis revealed that there were no significant correlation between BAL and severity of IVB, number of DAI and corpus callosum injury lesions. CONCLUSIONS Acute alcohol intoxication was not associated with type and number of DAI lesion, IVB and disability. This study suggested that a specific type of traumatic lesion, specifically lesion on genu of corpus callosum and IVB, might be more vital for outcome.
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