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

2010 ◽  
Vol 113 (3) ◽  
pp. 556-563 ◽  
Author(s):  
Toril Skandsen ◽  
Kjell Arne Kvistad ◽  
Ole Solheim ◽  
Ingrid Haavde Strand ◽  
Mari Folvik ◽  
...  
Keyword(s):  
Cohort Study ◽  
Head Injury ◽  
Mr Imaging ◽  
Acute Phase ◽  
Severe Head Injury ◽  
Axonal Injury ◽  
Diffuse Axonal Injury ◽  
Level Of Consciousness ◽  
Gcs Score ◽  
Stage 1

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.

Coexisting Diffuse Axonal Injury (DAI) and Outcome of Severe Head Injury

1992 ◽  
pp. 37-39 ◽  
Author(s):  
Minoru Shigemori ◽  
N. Kikuchi ◽  
T. Tokutomi ◽  
S. Ochiai ◽  
S. Kuramoto
Keyword(s):  
Head Injury ◽  
Severe Head Injury ◽  
Axonal Injury ◽  
Diffuse Axonal Injury

scholarly journals Diffuse Axonal Injury and Early Intracranial Sequelae in Severe Head Injury

1991 ◽  
Vol 31 (7) ◽  
pp. 390-395 ◽  
Author(s):  
Minoru SHIGEMORI ◽  
Takashi TOKUTOMI ◽  
Shinken KURAMOTO ◽  
Takumi MORIYAMA ◽  
Naomi KIKUCHI ◽  
...  
Keyword(s):  
Head Injury ◽  
Severe Head Injury ◽  
Axonal Injury ◽  
Diffuse Axonal Injury

scholarly journals GCS score and MRI grading does not predicts the outcome in dai patients - a prospective study

2018 ◽  
Vol 32 (2) ◽  
pp. 314-321
Author(s):  
Ketan Hedaoo ◽  
Vikas Rajpurohit ◽  
Sunil Garg ◽  
Sharad Thanvi ◽  
Vallabh B. Nagocha
Keyword(s):  
Head Injury ◽  
Hospital Stay ◽  
Axonal Injury ◽  
Diffuse Axonal Injury ◽  
Ventilator Associated Pneumonia ◽  
Icu Stay ◽  
Grade Ii ◽  
Gcs Score ◽  
Time Of Admission ◽  
Grade Iii

Abstract Diffuse axonal injury (DAI) is a type of brain injury due to extensive lesions in white matter tract occurring over a wide area. It is one of the most common and devastating types of traumatic brain injury and major cause of unconsciousness and persistent vegetative state after head trauma. DAI occurs in about half of all cases of severe head trauma. The study was undertaken to correlate the GCS at time of admission and Grade of DAI with the outcome. Aim: - To correlate GCS Score and MRI grading with the outcome in DAI patients. Setting and Design: - A 3 months prospective study was conducted in Department of Neurosurgery. Material and Method: - Sources of Data: - Patients admitted with clinical diagnosis of Diffuse Axonal Injury under Department of Neurosurgery. Sample size: - 50 cases of Diffuse Axonal Injury. Inclusion Criteria: - All traumatic DAI Patients requiring ICU care. Exclusion Criteria: - Head injury patients requiring Surgery. Patients other findings on imaging as contusion, EDH, SDH, IVH.Patients with Sepsis. Patients with other co morbid Illness as DM, Hypertension. Patients who were haemodynamically unstable at the time of admission. Patients with other systemic injuries. Statistical Analysis. Data so collected was analysed using IBM SPSS Statistics Windows, version 20.0 (Armonk, NY: IBM Corp) for the generation of descriptive and inferential statistics. The statistical significant difference among age groups was determined by Chi square test and one way analyses of variance. The level of significance was set at p˂0.05. Results: Distribution of patients according to Gender and MRI Grading shown in Table 1. Total 50 patients were evaluated out of which 38 (76%) were male and 12 (24%) were female. Number of patients according to Grading [Table 2 and Fig. 1] Out of 50 patients admitted 10% (5) constitutes Grade 1 DAI, 28% (14) grade II, and 62% (31) Grade III. Grades of DAI according to age of patients [Table 3]. Mean age in Grade I patients was 20.83±3.63, Grade II 23.36±7.089 and in Grade III 22.32±11.38. Comparisons of Mean ICU stay Mean Hospital stay and Mortality in Different GCS Groups [Table 4]. In patients with GCS 3-8 the mean ICU stay was 18.48±14.53, mean hospital stay was 37.24±12.31 and Mortality was 15.21%, in patients with GCS 9-12, mean ICU stay was 10.5±4.12, Hospital stay 19.4±5.79 and mortality was 25%. Comparison of Mean ICU stay, and Ventilator stay in different MRI Grade [Table 5]. In patients with Grade I DAI Mean ICU stay was 17.13±14.65 and Mean Ventilator stay was 6.24±2.57, In Grade II DAI mean ICU stay was 20.57±15.45 and Ventilator stay was 12.01±3.82 and in Grade III mean ICU stay was 23.4±15.41 and mean Ventilator stay was 10.89±2.58. Mortality of patients in different Grades and GCS groups [Table 6 and Fig 2] In patients with GCS 9-12 and Grade III only 1 patient died, while in patients with GCS 3- 8 total 7 died, 2 in Grade I, 2 in Grade II and 3 in Grade III. Complications [Table 7] Out of 5 patients in Grade I, electrolyte imbalance was seen in 1 patient in the form of hypernatraemia, 1 patient developed seizure, and septicaemia was seen in 1 and 1 patient developed shock. In patients with Grade II DAI out of 14 patients 1 had ventilator associated pneumonia, hypernatraemia was seen in 1, 1patient developed bed sore, seizures seen in 3, 2 had septicaemia & shock was seen in 2, and in 1drug reaction occurred. Out of 31 patients with Grade III DAI 2 developed ventilator associated pneumonia, hypernatraemia and hyponatraemia was seen in 2 & 1 patient respectively, 2 developed bedsore, seizure in 1 and septicaemia and shock was seen in 3-3 patients. Conclusion:-Diffuse axonal injury is a very common finding in traumatic head injury patients. Magnetic resonance imaging and GCS scoring does not have appropriate prognostic value in pure DAI patients and a better survival rate can be achieved with dedicated neurocritical care and neurosurgical management.

scholarly journals Diffuse axonal injury in non-missile head injury.

1991 ◽  
Vol 54 (6) ◽  
pp. 481-483 ◽  
Author(s):  
J H Adams ◽  
D I Graham ◽  
T A Gennarelli ◽  
W L Maxwell
Keyword(s):  
Head Injury ◽  
Axonal Injury ◽  
Diffuse Axonal Injury

scholarly journals Evaluation of Head Injury Criteria for Injury Prediction Effectiveness: Computational Reconstruction of Real-World Vulnerable Road User Impact Accidents

2021 ◽  
Vol 9 ◽  
Author(s):  
Fang Wang ◽  
Zhen Wang ◽  
Lin Hu ◽  
Hongzhen Xu ◽  
Chao Yu ◽  
...  
Keyword(s):  
Head Injury ◽  
Real World ◽  
Head Injuries ◽  
Axonal Injury ◽  
Diffuse Axonal Injury ◽  
Road User ◽  
Injury Criteria ◽  
Brain Deformation ◽  
Vulnerable Road User ◽  
Head Injury Criteria

This study evaluates the effectiveness of various widely used head injury criteria (HICs) in predicting vulnerable road user (VRU) head injuries due to road traffic accidents. Thirty-one real-world car-to-VRU impact accident cases with detailed head injury records were collected and replicated through the computational biomechanics method; head injuries observed in the analyzed accidents were reconstructed by using a finite element (FE)-multibody (MB) coupled pedestrian model [including the Total Human Model for Safety (THUMS) head–neck FE model and the remaining body segments of TNO MB pedestrian model], which was developed and validated in our previous study. Various typical HICs were used to predict head injuries in all accident cases. Pearson’s correlation coefficient analysis method was adopted to investigate the correlation between head kinematics-based injury criteria and the actual head injury of VRU; the effectiveness of brain deformation-based injury criteria in predicting typical brain injuries [such as diffuse axonal injury diffuse axonal injury (DAI) and contusion] was assessed by using head injury risk curves reported in the literature. Results showed that for head kinematics-based injury criteria, the most widely used HICs and head impact power (HIP) can accurately and effectively predict head injury, whereas for brain deformation-based injury criteria, the maximum principal strain (MPS) behaves better than cumulative strain damage measure (CSDM0.15 and CSDM0.25) in predicting the possibility of DAI. In comparison with the dilatation damage measure (DDM), MPS seems to better predict the risk of brain contusion.

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