Late CT findings in brain trauma: relationship to cognitive and behavioral sequelae and to vocational outcome.

OBJECTIVE

The purpose of this study was to determine the degree of correlation between cerebral atrophy observed on CT scans after severe blunt brain trauma and later neuropsychological status, as well as to evaluate the relative prognostic values of a number of indexes of cerebral atrophy.

MATERIALS AND METHODS

The study group comprised 32 previously healthy men 18-65 years old who had severe blunt trauma of the brain (initial scores on Glasgow coma scale of 7 or less). Their cognitive and behavioral statuses were evaluated when the patients were discharged from the hospital, which occurred when the recovery process showed a plateau. Overall vocational status was evaluated 1 year after discharge. The clinical evaluation was performed by a multidisciplinary team. Multiple linear indexes derived from brain CT scans obtained about 3 months after injury in patients with blunt brain trauma were correlated with cognitive and behavioral sequelae of brain damage and with vocational placement, as evaluated by a rehabilitation team about 1 year after trauma.

RESULTS

A high correlation was found between the width of the third ventricle and outcome. The prognostic value of the width of the third ventricle was superior to that of any other index studied, and it correlated best with late cognitive status (Spearman r = .57, p < .01).

CONCLUSION

The width of the third ventricle is a useful prognostic index in cases of diffuse brain trauma. It indicates diencephalic atrophy, caused either by diffuse axonal injury or by hypoxia. It may indicate a role of diencephalic structures in higher cortical functions.