Sandhu Sukhwinder, Soule Erik, Fiester Peter, Natter Patrick, Tavanaiepour Daryoush, Rahmathulla Gazanfar, Rao Dinesh
Department of Neuroradiology, Mayo Clinic, University of Florida Health, Jacksonville, Florida, USA.
Departments of Interventional Radiology, University of Florida Health, Jacksonville, Florida, USA.
J Clin Imaging Sci. 2019 Jun 28;9:32. doi: 10.25259/JCIS-11-2019. eCollection 2019.
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.
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.
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.
These results suggest that large, numerous pontine lesions may indicate worse neurological outcomes in patients with these findings.
严重创伤性脑损伤（TBI）通常由机动车事故引起，可能导致死亡和长期残疾，尤其是当大脑受到的加减速力巨大时。这可能会在一个被称为弥漫性轴索损伤（DAI）的过程中导致大脑皮层和脑干内轴突连接的剪切。广泛的DAI被认为是神经功能恢复的不良预后指标。在我们机构，观察到几名3级DAI患者尽管存在脑干损伤，但仍恢复并取得了优于预期的神经功能结果。
由两名经过专科培训的神经放射科医生对一家大型三级创伤中心收治的100例TBI患者的MRI研究进行回顾性分析。测量并记录DAI病变的大小、脑干内损伤的位置以及离散DAI病变的数量。记录患者入院时和出院时的格拉斯哥昏迷量表（GCS）评分，以及是否存在其他神经损伤。
最初被诊断为患有脑干病变的DAI的20例患者中，有8例出院时格拉斯哥昏迷量表（GCS）评分为14 - 15分。另外12例出院时意识减退（平均GCS 7.1分）的患者表现出更多、更大的病变，且病变多位于脑桥背侧。
这些结果表明，对于有这些表现的患者，大量、多发性脑桥病变可能预示着更差的神经功能结果。
