Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Neurocrit Care. 2017 Oct;27(2):199-207. doi: 10.1007/s12028-017-0399-2.
Recovery of functional independence is possible in patients with brainstem traumatic axonal injury (TAI), also referred to as "grade 3 diffuse axonal injury," but acute prognostic biomarkers are lacking. We hypothesized that the extent of dorsal brainstem TAI measured by burden of traumatic microbleeds (TMBs) correlates with 1-year functional outcome more strongly than does ventral brainstem, corpus callosal, or global brain TMB burden. Further, we hypothesized that TMBs within brainstem nuclei of the ascending arousal network (AAN) correlate with 1-year outcome.
Using a prospective outcome database of patients treated for moderate-to-severe traumatic brain injury at an inpatient rehabilitation hospital, we retrospectively identified 39 patients who underwent acute gradient-recalled echo (GRE) magnetic resonance imaging (MRI). TMBs were counted on the acute GRE scans globally and in the dorsal brainstem, ventral brainstem, and corpus callosum. TMBs were also mapped onto an atlas of AAN nuclei. The primary outcome was the disability rating scale (DRS) score at 1 year post-injury. Associations between regional TMBs, AAN TMB volume, and 1-year DRS score were assessed by calculating Spearman rank correlation coefficients.
Mean ± SD number of TMBs was: dorsal brainstem = 0.7 ± 1.4, ventral brainstem = 0.2 ± 0.6, corpus callosum = 1.8 ± 2.8, and global = 14.4 ± 12.5. The mean ± SD TMB volume within AAN nuclei was 6.1 ± 18.7 mm. Increased dorsal brainstem TMBs and larger AAN TMB volume correlated with worse 1-year outcomes (R = 0.37, p = 0.02, and R = 0.36, p = 0.02, respectively). Global, callosal, and ventral brainstem TMBs did not correlate with outcomes.
These findings suggest that dorsal brainstem TAI, especially involving AAN nuclei, may have greater prognostic utility than the total number of lesions in the brain or brainstem.
脑干部创伤性轴索损伤（TAI）又称“3 级弥漫性轴索损伤”的患者有可能恢复功能独立性，但目前缺乏急性预后生物标志物。我们假设，通过创伤性微出血（TMB）负担来测量的背侧脑干 TAI 的程度与 1 年的功能结果相关性比腹侧脑干、胼胝体或全脑 TMB 负担更强。此外，我们假设脑干上升觉醒网络（AAN）核内的 TMB 与 1 年的结果相关。
使用在住院康复医院治疗中度至重度创伤性脑损伤患者的前瞻性结局数据库，我们回顾性地确定了 39 名接受急性梯度回波（GRE）磁共振成像（MRI）的患者。在急性 GRE 扫描中对 TMB 进行了全球和背侧脑干、腹侧脑干和胼胝体的计数。TMB 还被映射到 AAN 核图谱上。主要结局是损伤后 1 年的残疾评定量表（DRS）评分。通过计算 Spearman 秩相关系数评估局部 TMB、AAN TMB 体积与 1 年 DRS 评分之间的相关性。
平均±标准差 TMB 数为：背侧脑干=0.7±1.4，腹侧脑干=0.2±0.6，胼胝体=1.8±2.8，全球=14.4±12.5。AAN 核内 TMB 体积的平均±标准差为 6.1±18.7mm。背侧脑干 TMB 增加和 AAN TMB 体积较大与 1 年结局较差相关（R=0.37，p=0.02 和 R=0.36，p=0.02）。全球、胼胝体和腹侧脑干 TMB 与结局无相关性。
这些发现表明，背侧脑干 TAI，特别是涉及 AAN 核，可能比大脑或脑干中的病变总数具有更大的预后价值。
