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Original research article


Brainstem Diffuse Axonal Injury and Consciousness

Sukhwinder Sandhu1Erik Soule2Peter Fiester3Patrick Natter3Daryoush Tavanaiepour4Gazanfar Rahmathulla4Dinesh Rao3
1Department of Neuroradiology, Mayo Clinic, 2Departments of Interventional Radiology, 3Neuroradiology, 4Neurosurgery, University of Florida Health, Jacksonville, Florida, USA.
Date of Submission: 29-Mar-2019, Date of Acceptance: 04-Jun-2019, Date of Web Publication: 28-Jun-2019.
Corresponding Author:
Corresponding Author

Erik Soule

E-mail: erik.soule@jax.ufl.edu

Corresponding Author:
Corresponding Author

Erik Soule

E-mail: erik.soule@jax.ufl.edu

DOI: 10.25259/JCIS-11-2019 Facebook Twitter Google Linkedin

ABSTRACT



Background: Severe traumatic brain injuries (TBI), commonly due to motor vehicle accidents may cause death and long-term disability especially when the acceleration-deceleration force on the brain is massive. This may cause shearing of the axonal connections within the cerebral cortex and brainstem in a process referred to as diffuse axonal injury (DAI). Extensive DAI has been postulated to be a poor prognostic indicator for neurological recovery. In our institution, several patients with Grade 3 DAI were observed to recover and achieve neurological outcomes greater than expected given the presence of brainstem injury.
Methods: MRI studies from 100 patients admitted to a large tertiary trauma center for TBI were retrospectively analyzed by two fellowship-trained neuroradiologists. The size of DAI lesions, location of injury within the brainstem, and the number of discrete DAI lesions were measured and recorded. Glasgow Coma Scale (GCS) on arrival and at discharge was noted, as well as the presence of other neurological injuries.
Results: Of 20 patients initially noted to have DAI with lesions of the brainstem, eight of them were discharged with Glasgow Coma Scale (GCS) of 14–15. The 12 patients discharged with reduced consciousness (average GC 7.1) demonstrated a greater number of larger lesions, with a predilection for the dorsal pons.
Conclusion: These results suggest that large, numerous pontine lesions may indicate worse neurological outcomes in patients with these findings.
Keywords: Traumatic brain injury, Diffuse axonal injury, Magnetic resonance imaging, Ascending reticular activating system, Consciousness

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