PATTERNS OF DIFFUSE AXONAL INJURY IN TRAUMATIC HEAD INJURY PATIENTS - A CT SCAN BASED STUDY FROM LIAQUAT NATIONAL HOSPITAL, KARACHI

Syed Shariq ullah

Abstract


ABSTRACT

 Objective:

The aim of this study was to record the incidence of patterns of diffuse axonal injury in traumatic head injury patients, that presented to a tertiary care hospital over a period of 06 months.

Methods:

A retrospective, cross-sectional study was performed on data collected from computerized records and CT scan images of cases of traumatic head injury patients. The data was collected over a period of 06 months; from 01st July 2016 to 31st December 2016. The study center was the Department of Radiology, at Liaquat National Hospital, Karachi.

Results:

A total of 123 patients presented to Liaquat National Hospital, Department of Radiology with the history of traumatic head injury over a period of 06 months. Only 23 out of these 123 patients (18.6%) who were clinically suspected of having diffuse axonal injury showed its different patterns confirmed on CT scan. 18 patients (78.2%) had contusions at gray white matter interface, 07 patients (30.4%) had contusions in corpus callosum, 04 patients (17.3%) had contusions in brain stem, 14 patients (60.8%) had contusions in cerebellum, 15 patients (65.2%) had skull fractures, 05 patients (21.7%) had intraventricular bleed while only 02 patients (8.6%) had global cerebral ischemia. The rest of 100 patients showed skull fractures, intra and extra axial bleeds with parenchymal contusions.

Conclusion:

The incidence of diffuse axonal injury is rare and is very low, but not uncommon in patients of traumatic head injury and cannot be disregarded. Timely diagnosis and management will be useful to lower morbidity and mortality.

KEYWORDS: Diffuse axonal injury, CT scan

Full Text:

PDF

References


Narayan RK, Michel ME, Ansell B, Baethmann A, Biegon A, Bracken MB, et al. Clinical trials in head injury. J Neurotrauma. 2002; 19: 503–557. PMID: 12042091

Skandsen T, Kvistad KA, Solheim O, Strand IH, Folvik M, Vik A. Prevalence and impact of diffuse axonal injury in patients with moderate and severe head injury: a cohort study of early magnetic resonance imaging findings and 1 year outcome. J Neurosurg. 2010; 113: 556-563. doi: 10.3171/2009.9. JNS09626 PMID: 19852541

Scheid R, von Cramon DY Clinical findings in the chronic phase of traumatic brain injury: data from 12 years' experience in the Cognitive Neurology Outpatient Clinic at the University of Leipzig. Dtsch Arztebl Int.2010; 107: 199-205. doi: 10.3238/arztebl.2010.0199 PMID: 20386669

Wallesch CW, Curio N, Kutz S, Jost S, Bartels C, Synowitz H. Outcome after mild-to-moderate blunt head injury: effects of focal lesions and diffuse axonal injury. Brain Inj. 2001; 15: 401–412. PMID: 11350654

Strich SJ. Diffuse degeneration of cerebral white matter in severe dementia following head injury. J Neurol Neurosurg Psychiatry 1956; 19:163-85.

Strich SJ. Shearing of nerve fibres as a cause of brain damage due to head injury: a pathological study of 20 cases. Lancet 1961; 2:443-8.

Aoki Y, Inokuchi R, Gunshin M, Yahagi N, Suwa H. Diffusion tensor imaging studies of mild traumatic brain injury: a meta-analysis. J Neurol Neurosurg Psychiatry. 2012; 83: 870–876.

Babikian T, Freier MC, Tong KA, Nickerson JP, Wall CJ, Holshouser BA, Burley T, Riggs ML, Ashwal S. Susceptibility weighted imaging: neuropsychologic outcome and pediatric head injury. Pediatr Neurol. 2005; 33: 184–194.

Cai J, Ma H, Huang F, Zhu D, Bi J, Ke Y, Zhang T. Correlation of bevacizumab-induced hypertension and outcomes of metastatic colorectal cancer patients treated with bevacizumab: a systematic review and meta-analysis. World J Surg Oncol. 2013; 11:306.

Gentry LR (1994) Imaging of closed head injury. Radiology 191: 1±17

Hesselink JR, Dowd CF, Healy ME, Hajek P, Baker LL, Luerssen TG (1988) MR imaging of brain contusions: a comparative study with CT. AJR Am J Roentgenol 150: 1133±1142

Adams JH, Doyle D, Ford I, Gennarelli TA, Graham DI, McLellan DR. Diffuse axonal injury in head injury: definition, diagnosis and grading. Histopathology. 1989; 15: 49–59. PMID:2767623

Scheid R, Ott DV, Roth H, Schroeter ML, von Cramon DY. Comparative magnetic resonance imaging at 1.5 and 3 Tesla for the evaluation of traumatic microbleeds. J Neurotrauma. 2007; 24: 1811–1816. PMID:18159992

Cai J, Ma H, Huang F, Zhu D, Bi J, Ke Y, Zhang T. Correlation of bevacizumab-induced hypertension and outcomes of metastatic colorectal cancer patients treated with bevacizumab: a systematic review and meta-analysis. World J Surg Oncol. 2013; 11: 306.

Chastain CA, Oyoyo UE, Zipperman M, Joo E, Ashwal S, Shutter LA, Tong KA. Predicting outcomes of traumatic brain injury by imaging modality and injury distribution. J Neurotrauma. 2009; 26: 1183–1196.

Chen C, He C, Zhu D, Guo R, Zhang F, Pan S. Generation of a flat optical frequency comb based on a cascaded polarization modulator and phase modulator. Opt Lett. 2013a; 38: 3137–3139.

Chen J, Zhou C, Wu B, Wang Y, Li Q, Wei Y, Yang D, Mu J, Zhu D, Zou D, Xie P. Left versus right repetitive transcranial magnetic stimulation in treating major depression: a meta-analysis of randomised controlled trials. Psychiatry Res. 2013; 210:1260–1264.

Ju MJ, Tu GW, Han Y, He HY, He YZ, Mao HL, Wu ZG, Yin YQ, Luo JF, Zhu DM, Luo Z, Xue ZG. Effect of admission time on mortality in an intensive care unit in Mainland China: a propensity score matching analysis. Crit Care. 2013; 17:R230.

Costello MG, Zhu D, Salinas E, Stanford TR. Perceptual modulation of motor--but not visual--responses in the frontal eye field during an urgent-decision task. J Neurosci. 2013; 33:16394–16408.

Springer JE, Nottingham SA, McEwen ML, Azbill RD, Jin Y. Caspase-3 apoptotic signaling following injury to the central nervous system. Clin Chem Lab Med 2001; 39:299-307.

Büki A, Okonkwo DO, Wang KK, Povlishock JT. Cytochrome c release and caspase activation in traumatic axonal injury. J Neurosci 2000; 20:2825-34.

Adams JH, Graham DI, Murray LS, et al. Diffuse axonal injury due to nonmissile head injury in humans: an analysis of 45 cases. Ann Neurol 1982; 12:557–63.

Gennarelli TA, Thibault LE, Adams JH, et al. Diffuse axonal injury and traumatic coma in the primate. Ann Neurol 1982; 12:564–74.

Adams JH, Doyle D, Ford I, et al. Diffuse axonal injury in head injury: definition, diagnosis and grading. Histopathology 1989; 15:49–59.

Meythaler JM, Peduzzi JD, Eleftheriou E, Novack TA. Current concepts: diffuse axonal injury-associated traumatic brain injury. Arch Phys Med Rehabil 2000;82:1461–1471


Refbacks

  • There are currently no refbacks.


© Copyright PJR 2008-