Antero posterior elongation of midbrain in traumatic brain injury- significant sign yet a mistaken entity.

BACKGROUND

Antero posterior elongation of the midbrain is observed occasionally in severe traumatic brain injury and generally implies a bad outcome. The objective of the study was to document midbrain elongation and identify the implications of this finding.

METHODS

This prospective study included 100 patients with traumatic intracranial haematoma of more than 20 cc in volume. Key measurements were taken in the midbrain and pontine regions and the status of perimesencephalic basal cisterns was noted. All the predictors were analyzed for the outcome.

RESULTS

In twenty-nine patients the distorted midbrain appeared to be elongated in the antero posterior direction on visual inspection of CT head images. However, on statistical analysis, it was made out that there is no demonstrable anteroposterior lengthening of the midbrain. The factors influencing the appearance and outcome were discussed.

CONCLUSIONS

Although not a true sign, the finding of the elongated appearance of the midbrain in traumatic brain injury still holds significance as a predictor of mortality. Hence, this finding should alert neurosurgeons or intensivists to expedite the administration of suitable interventions in a salvageable patient.