Absent or compressed basal cisterns on first CT scan: ominous predictors of outcome in severe head injury

Restricted access

✓ The relationship of outcome to the appearance of the basal cisterns as seen on initial computerized tomography (CT) scanning was assessed in 218 consecutive severely head-injured patients entered into the second phase of the National Pilot Traumatic Coma Data Bank. Outcome could be directly related to the status of the basal cisterns on the initial CT scan. The mortality rates were 77%, 39%, and 22% among those with absent, compressed, and normal basal cisterns, respectively. This association between cisterns and outcome was shown to be strong after adjusting for Glasgow Coma Scale (GCS) score (p < 0.001).

The state of the cisterns was more important for those with higher GCS scores (scores 6 to 8) than for those with lower scores (scores 3 to 5). Patients with GCS scores of 6 to 8, with cisterns absent or not visualized, suffered nearly a fourfold additional risk of poor outcome, compared to those with normal cisterns. This indicates that the status of the cisterns can be used as an early noninvasive method of identifying patients at high risk of death or severe disability, in whom the initial neurological examination would potentially suggest otherwise.

Article Information

Contributor Notes

Address reprint requests to: Lawrence F. Marshall, M.D., University Hospital H-893, University of California Medical Center, 225 Dickinson Street, San Diego, California 92103.
Headings
References
  • 1.

    Becker DPMiller JDWard JDet al: The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 47:4915021977Becker DP Miller JD Ward JD et al: The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 47:491–502 1977

    • Search Google Scholar
    • Export Citation
  • 2.

    Carlsson CAvon Essen CLöfgren J: Factors affecting the clinical course of patients with severe head injuries. Part 1: Influence of biological factors. Part 2: Significance of posttraumatic coma. J Neurosurg 29:2422511968Carlsson CA von Essen C Löfgren J: Factors affecting the clinical course of patients with severe head injuries. Part 1: Influence of biological factors. Part 2: Significance of posttraumatic coma. J Neurosurg 29:242–251 1968

    • Search Google Scholar
    • Export Citation
  • 3.

    Clifton GLGrossman RGMakela MEet al: Neurological course and correlated computerized tomography findings after severe closed head injury. J Neurosurg 52:6116241980Clifton GL Grossman RG Makela ME et al: Neurological course and correlated computerized tomography findings after severe closed head injury. J Neurosurg 52:611–624 1980

    • Search Google Scholar
    • Export Citation
  • 4.

    Cordobés Fde la Fuente MLobato RDet al: Intraventricular hemorrhage in severe head injury. J Neurosurg 58:2172221983Cordobés F de la Fuente M Lobato RD et al: Intraventricular hemorrhage in severe head injury. J Neurosurg 58:217–222 1983

    • Search Google Scholar
    • Export Citation
  • 5.

    Gutterman PShenkin HA: Prognostic features in recovery from traumatic decerebration. J Neurosurg 32:3303351970Gutterman P Shenkin HA: Prognostic features in recovery from traumatic decerebration. J Neurosurg 32:330–335 1970

    • Search Google Scholar
    • Export Citation
  • 6.

    Jennett BBond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:4804841975Jennett B Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480–484 1975

    • Search Google Scholar
    • Export Citation
  • 7.

    Jennett BTeasdale GBraakman Ret al: Predicting outcome in individual patients after severe head injury. Lancet 1:103110341976Jennett B Teasdale G Braakman R et al: Predicting outcome in individual patients after severe head injury. Lancet 1:1031–1034 1976

    • Search Google Scholar
    • Export Citation
  • 8.

    Klauber MRToutant SMMarshall LF: A model for predicting delayed intracranial hypertension following severe head injury. J Neurosurg 61:6956991984Klauber MR Toutant SM Marshall LF: A model for predicting delayed intracranial hypertension following severe head injury. J Neurosurg 61:695–699 1984

    • Search Google Scholar
    • Export Citation
  • 9.

    Levati AFarina MLVecchi Get al: Prognosis of severe head injuries. J Neurosurg 57:7797831982Levati A Farina ML Vecchi G et al: Prognosis of severe head injuries. J Neurosurg 57:779–783 1982

    • Search Google Scholar
    • Export Citation
  • 10.

    Mantel N: Chi-square tests with one degree of freedom; extensions of the Mantel-Haenszel procedure. J Am Statist Assoc 58:6907001963Mantel N: Chi-square tests with one degree of freedom; extensions of the Mantel-Haenszel procedure. J Am Statist Assoc 58:690–700 1963

    • Search Google Scholar
    • Export Citation
  • 11.

    Murphy ATeasdale EMatheson Met al: Relationship between CT indices of brain swelling and intracranial pressure after head injury in Ishii SNagai HBrock M (eds): Intracranial Pressure V. Berlin/Heidelberg/New York: Springer-Verlag1983 pp 562565Murphy A Teasdale E Matheson M et al: Relationship between CT indices of brain swelling and intracranial pressure after head injury in Ishii S Nagai H Brock M (eds): Intracranial Pressure V. Berlin/Heidelberg/New York: Springer-Verlag 1983 pp 562–565

    • Search Google Scholar
    • Export Citation
  • 12.

    Rea GLRockswold GL: Barbiturate therapy in uncontrolled intracranial hypertension. Neurosurgery 12:4014041983Rea GL Rockswold GL: Barbiturate therapy in uncontrolled intracranial hypertension. Neurosurgery 12:401–404 1983

    • Search Google Scholar
    • Export Citation
  • 13.

    Sweet RCMiller JDLipper Met al: Significance of bilateral abnormalities on the CT scan in patients with severe head injury. Neurosurgery 3:16211978Sweet RC Miller JD Lipper M et al: Significance of bilateral abnormalities on the CT scan in patients with severe head injury. Neurosurgery 3:16–21 1978

    • Search Google Scholar
    • Export Citation
  • 14.

    van Dongen KJBraakman RGelpke GJ: The prognostic value of computerized tomography in comatose head-injured patients. J Neurosurg 59:9519571983van Dongen KJ Braakman R Gelpke GJ: The prognostic value of computerized tomography in comatose head-injured patients. J Neurosurg 59:951–957 1983

    • Search Google Scholar
    • Export Citation
TrendMD
Cited By
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 467 442 38
Full Text Views 311 139 0
PDF Downloads 130 32 0
EPUB Downloads 0 0 0
PubMed
Google Scholar