Genu of corpus callosum as a prognostic factor in diffuse axonal injury

Clinical article

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Object

Previous studies have shown a relationship between a patient's stage of diffuse axonal injury (DAI) and outcome. However, few studies have assessed whether a specific lesion or type of corpus callosum injury (CCI) influences outcome in patients with DAI. The authors investigated the effect of various DAIs and CCIs on outcome in patients with traumatic brain injury (TBI).

Methods

The authors retrospectively reviewed 78 consecutive patients with DAI who were seen between May 2004 and March 2010. Outcome was evaluated using the Extended Glasgow Outcome Scale (EGOS) 1 year after TBI. Patients with single DAIs had only 1 of the 3 lesions (lobar, CC, or brainstem). Patients with dual DAIs had 2 of these lesions, and those with triple DAIs had all of these lesions. Furthermore, the authors defined single, dual, and triple CCIs by using 3 lesions (genu, body, splenium) in the same way among patients with single (CC) DAIs. Univariate and multivariate logistic regression analyses were performed to evaluate the relationships between these lesions and outcome in patients with DAI.

Results

Fifty patients had single DAIs: 34 in the lobar area, 11 in the CC, and 5 in the brainstem. Twenty had dual DAIs, and 8 had triple DAIs. Of the 11 CCIs, 9 were single and 2 were dual CCIs. Among these lesions, only those in the genu were related to disability. The authors dichotomized patients into those with and without genu lesions, regardless of other injuries. Multinomial logistic regression analysis showed that a genu lesion (OR 18, 95% CI 2.2–32; p = 0.0021) and a pupillary abnormality (OR 14, 95% CI 1.6–24; p = 0.0068) were associated with disability (EGOS ≤ 6) in patients with DAI.

Conclusions

Regardless of the number of lesions, the existence of a genu lesion suggested disability 1 year after TBI in patients with DAI.

Abbreviations used in this paper: CC = corpus callosum; CCI = CC injury; DAI = diffuse axonal injury; EGOS = Extended Glasgow Outcome Scale; GCS = Glasgow Coma Scale; GRE = gradient recalled echo; TBI = traumatic brain injury.

Article Information

Address correspondence to: Hidetoshi Matsukawa, M.D., Department of Neurosurgery, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo 104-8560, Japan. email: mahide@luke.or.jp.

Please include this information when citing this paper: published online July 22, 2011; DOI: 10.3171/2011.6.JNS11513.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Drawing illustrating the definitions of the regions of the CC, according to a modification of the Witelson scheme. A and B represent the most anterior and the most posterior points of the CC, respectively. C indicates the most anterior point on the inner convexity of the inner anterior CC. The solid line perpendicular to the A to B dashed line at point C divides the genu (area 1) and the body (area 2). D indicates the point of the posterior one-fifth region of the length of the A to B dashed line. The other solid line perpendicular to the A to B dashed line at point C divides the body (area 2) and the splenium (area 3).

  • View in gallery

    Representative sagittal T2-weighted MR images showing the 3 types of CCIs: genu (A), body (B), and splenium (C).

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