Early magnetic resonance imaging of brainstem lesions after severe head injury

Raimund Firsching Kliniks für Neurochirurgie und Diagnostische Radiologie, und Institut für Rechtsmedizin, Otto von Guericke Universität Magdeburg, Magdeburg, Germany

Search for other papers by Raimund Firsching in
Current site
Google Scholar
PubMed
Close
 Prof. Dr. med.
,
Dieter Woischneck Kliniks für Neurochirurgie und Diagnostische Radiologie, und Institut für Rechtsmedizin, Otto von Guericke Universität Magdeburg, Magdeburg, Germany

Search for other papers by Dieter Woischneck in
Current site
Google Scholar
PubMed
Close
 Dr. med.
,
Michael Diedrich Kliniks für Neurochirurgie und Diagnostische Radiologie, und Institut für Rechtsmedizin, Otto von Guericke Universität Magdeburg, Magdeburg, Germany

Search for other papers by Michael Diedrich in
Current site
Google Scholar
PubMed
Close
 Dr. med.
,
Susan Klein Kliniks für Neurochirurgie und Diagnostische Radiologie, und Institut für Rechtsmedizin, Otto von Guericke Universität Magdeburg, Magdeburg, Germany

Search for other papers by Susan Klein in
Current site
Google Scholar
PubMed
Close
 M.D.
,
Andreas Rückert Kliniks für Neurochirurgie und Diagnostische Radiologie, und Institut für Rechtsmedizin, Otto von Guericke Universität Magdeburg, Magdeburg, Germany

Search for other papers by Andreas Rückert in
Current site
Google Scholar
PubMed
Close
 M.D.
,
Holger Wittig Kliniks für Neurochirurgie und Diagnostische Radiologie, und Institut für Rechtsmedizin, Otto von Guericke Universität Magdeburg, Magdeburg, Germany

Search for other papers by Holger Wittig in
Current site
Google Scholar
PubMed
Close
 Dr. med.
, and
Wilfried Döhring Kliniks für Neurochirurgie und Diagnostische Radiologie, und Institut für Rechtsmedizin, Otto von Guericke Universität Magdeburg, Magdeburg, Germany

Search for other papers by Wilfried Döhring in
Current site
Google Scholar
PubMed
Close
 Prof. Dr. med.
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $536.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $636.00
USD  $45.00
USD  $536.00
USD  $636.00
Print or Print + Online Sign in

Object. The availability of magnetic resonance (MR) imaging data obtained in comatose patients after head injury is scarce, because MR imaging is somewhat cumbersome to perform in patients requiring ventilation and because, in the first hours after injury, its relevance is clearly inferior to computerized tomography (CT) scanning. The authors assessed the value of MR imaging in the early postinjury period.

Methods. In this prospective study MR imaging was performed in 61 consecutive patients within 7 days after they suffered a severe head injury. An initial CT scan had already been obtained. To understand the clinical significance of the lesions whose morphological appearance was identified with MR imaging, brainstem function was assessed by registration of somatosensory and auditory evoked potentials.

Brainstem lesions were visualized in 39 patients (64%). Bilateral pontine lesions proved to be 100% fatal and nonbrainstem lesions carried a mortality rate of 9%.

In singular cases circumstances allowed for a clear clinical distinction between primary and secondary brainstem lesions. On MR imaging all lesions were hyper- and hypointense after intervals longer than 2 days. Within shorter intervals (< 2 days) after the injury, primary lesions appeared isointense on MR imaging. In one secondary brainstem lesion there were no traces of blood.

Conclusions. Because mean intracranial pressure (ICP) levels in patients without brainstem lesions were similar to those in patients with brainstem lesions, the authors conclude that it was not mainly increased ICP that accounted for the high mortality rates in patients with brainstem lesions.

The authors also conclude that brainstem lesions are more frequently found in severe head injury than previously reported in studies based on neuropathological or CT scanning data. Early MR imaging after head injury has a higher predictive value than CT scanning.

  • Collapse
  • Expand
  • 1.

    Bernardi B, , Zimmerman RA, & Bilaniuk LT: Neuroradiologic evaluation of pediatric craniocerebral trauma. Top Magn Reson Imaging 5:161173, 1993 Bernardi B, Zimmerman RA, Bilaniuk LT: Neuroradiologic evaluation of pediatric craniocerebral trauma. Top Magn Reson Imaging 5:161–173, 1993

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Fernandez R, , Firsching R, & Lobato R, et al: Guidelines for treatment of head injury in adults. Opinions of a group of neurosurgeons. Zentralbl Neurochir 58:7274, 1997 Fernandez R, Firsching R, Lobato R, et al: Guidelines for treatment of head injury in adults. Opinions of a group of neurosurgeons. Zentralbl Neurochir 58:72–74, 1997

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Firsching R: Evoked potentials in head injury. Adv Neurotraumatol 3:229254, 1992 Firsching R: Evoked potentials in head injury. Adv Neurotraumatol 3:229–254, 1992

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Firsching R, & Frowein RA: Multimodality evoked potentials and early prognosis in comatose patients. Neurosurg Rev 13:141146, 1990 Firsching R, Frowein RA: Multimodality evoked potentials and early prognosis in comatose patients. Neurosurg Rev 13:141–146, 1990

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Frowein RA: Classification of coma. Acta Neurochir 34:510, 1976 Frowein RA: Classification of coma. Acta Neurochir 34:5–10, 1976

  • 6.

    Gentry LR, , Godersky JC, & Thompson B: MR imaging of head trauma: review of the distribution and radiopathologic features of traumatic lesions. AJR 150:663672, 1988 Gentry LR, Godersky JC, Thompson B: MR imaging of head trauma: review of the distribution and radiopathologic features of traumatic lesions. AJR 150:663–672, 1988

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Greenberg RP, , Newlon PG, & Hyatt MS, et al: Prognostic implications of early multimodality evoked potentials in severely head-injured patients. A prospective study. J Neurosurg 55:227236, 1981 Greenberg RP, Newlon PG, Hyatt MS, et al: Prognostic implications of early multimodality evoked potentials in severely head-injured patients. A prospective study. J Neurosurg 55:227–236, 1981

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Hashimoto T, , Nakamura N, & Richard KE, et al: Primary brain stem lesions caused by closed head injuries. Neurosurg Rev 16:291298, 1993 Hashimoto T, Nakamura N, Richard KE, et al: Primary brain stem lesions caused by closed head injuries. Neurosurg Rev 16:291–298, 1993

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Levin HS, , Mendelsohn D, & Lilly MA, et al: Magnetic resonance imaging in relation to functional outcome of pediatric closed head injury: a test of the Ommaya-Gennarelli model. Neurosurgery 40:432441, 1997 Levin HS, Mendelsohn D, Lilly MA, et al: Magnetic resonance imaging in relation to functional outcome of pediatric closed head injury: a test of the Ommaya-Gennarelli model. Neurosurgery 40:432–441, 1997

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Mitchell DE, & Adams JH: Primary focal impact damage to the brainstem in blunt head injuries. Does it exist? Lancet 2:215218, 1973 Mitchell DE, Adams JH: Primary focal impact damage to the brainstem in blunt head injuries. Does it exist? Lancet 2:215–218, 1973

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Mitchener A, , Wyper DJ, & Patterson J, et al: SPECT, CT, and MRI in head injury acute abnormalities followed up at six months. J Neurol Neurosurg Psychiatry 62:633636, 1997 Mitchener A, Wyper DJ, Patterson J, et al: SPECT, CT, and MRI in head injury acute abnormalities followed up at six months. J Neurol Neurosurg Psychiatry 62:633–636, 1997

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Teasdale G, & Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:8184, 1974 Teasdale G, Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–84, 1974

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Vuilleumier P, & Assal G: Lésions du corps calleux et syndromes de déconnexion interhémisphérique d'origine traumatique. Neurochirurgie 41:98107, 1995 Vuilleumier P, Assal G: Lésions du corps calleux et syndromes de déconnexion interhémisphérique d'origine traumatique. Neurochirurgie 41:98–107, 1995

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Wilson JT, , Teasdale GM, & Hadley DM, et al: Post-traumatic amnesia: still a valuable yardstick. J Neurol Neurosurg Psychiatry 57:198201, 1994 Wilson JT, Teasdale GM, Hadley DM, et al: Post-traumatic amnesia: still a valuable yardstick. J Neurol Neurosurg Psychiatry 57:198–201, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 817 116 22
Full Text Views 167 16 0
PDF Downloads 109 16 0
EPUB Downloads 0 0 0