Department of Neurosurgery, Gaffrée e Guinle University Hospital, School of Medicine, Federal University of Rio de Janeiro State, 775 Mariz e Barros Street, Rio de Janeiro, RJ, Brazil.
Neuroradiology. 2020 Jun;62(6):653-660. doi: 10.1007/s00234-020-02383-2. Epub 2020 Mar 4.
Diffuse axonal injury (DAI) is the rupture of multiple axons due to acceleration and deceleration forces during a closed head injury. Most traumatic brain injuries (TBI) have some degree of DAI, especially severe TBI. Computed tomography (CT) remains the first imaging test performed in the acute phase of TBI, but has low sensitivity for detecting DAI, since DAI is a cellular lesion. The aim of this study is to search in the literature for CT signs, in the first 24 h after TBI, that may help to differentiate patients in groups with a better versus worst prognosis.
We searched for primary scientific articles in the PubMed database, in English, indexed since January 1st, 2000.
Five articles were selected for review. In the DAI group, traffic accidents accounted 70% of the cases, 79% were male, and the mean age was 41 years. There was an association between DAI and intraventricular hemorrhage (IVH) and traumatic subarachnoid hemorrhage (tSAH); an association between the IVH grade and number of corpus callosum lesions; and an association between blood in the interpeduncular cisterns (IPC) and brainstem lesions.
In closed TBI with no tSAH, severe DAI is unlikely. Similarly, in the absence of IVH, any DAI is unlikely. If there is IVH, patients generally are clinically worse; and the more ventricles affected, the worse the prognosis.
弥漫性轴索损伤（DAI）是由于头部闭合伤时的加速和减速力导致的多个轴索断裂。大多数创伤性脑损伤（TBI）都有一定程度的 DAI，尤其是严重的 TBI。计算机断层扫描（CT）仍然是 TBI 急性期进行的首次影像学检查，但对 DAI 的敏感性较低，因为 DAI 是一种细胞病变。本研究旨在文献中搜索 TBI 后 24 小时内的 CT 征象，以帮助区分预后较好和较差的患者。
我们在 PubMed 数据库中搜索了自 2000 年 1 月 1 日起以英文发表的原始科学文章。
筛选出 5 篇文章进行综述。在 DAI 组中，交通事故占 70%，79%为男性，平均年龄为 41 岁。DAI 与脑室出血（IVH）和外伤性蛛网膜下腔出血（tSAH）有关；IVH 分级与胼胝体病变数量有关；脚间池（IPC）内有血液与脑干病变有关。
在没有 tSAH 的闭合性 TBI 中，不太可能发生严重的 DAI。同样，如果没有 IVH，则不太可能发生任何 DAI。如果有 IVH，患者通常病情更严重；受影响的脑室越多，预后越差。
