Magnetic resonance imaging and computerized tomography in relation to the neurobehavioral sequelae of mild and moderate head injuries

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✓ Twenty patients admitted for minor or moderate closed-head injury were studied to investigate the relationship between magnetic resonance imaging (MRI) and neurobehavioral sequelae. The MRI scans demonstrated 44 more intracranial lesions than did concurrent computerized tomography (CT) scans in 17 patients (85%); most of these lesions were located in the frontal and temporal regions. Estimates of lesion volume based on MRI were frequently greater than with CT; however, MRI disclosed no additional lesions that required surgical evacuation. Neuropsychological assessment during the initial hospitalization revealed deficits in frontal lobe functioning and memory that were related to the size and localization of the lesions as defined by MRI. Follow-up MRI and neuropsychological testing at 1 month (13 cases) and 3 months (six cases) disclosed marked reduction of lesion size paralleled by improvement in cognition and memory. These findings encourage further investigation of the prognostic utility of MRI for the clinical management and rehabilitation of mild or moderate head injury.

Article Information

Address reprint requests to: Harvey S. Levin, Ph.D., Division of Neurosurgery, University of Texas Medical Branch, Galveston, Texas 77550.

© AANS, except where prohibited by US copyright law.

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Figures

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    Intrahemispheric locus of lesion disclosed by computerized tomography (CT) versus magnetic resonance imaging (MRI) in 20 patients with minor or moderate head injury.

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    Comparison of size of intracranial lesion visualized by computerized tomography (CT) versus magnetic resonance imaging (MRI). Vertical and horizontal lines demarcate potentially surgical lesions that were at least 25 cc in volume. The findings were obtained in the total series of 20 patients with minor or moderate head injury.

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    Neuropsychological test performance in head-injured patients with focal lesions visualized by magnetic resonance imaging in the frontal and/or temporal regions. To permit direct comparison of design fluency (a measure of frontal lobe functioning) with verbal memory retrieval (a measure primarily of temporal lobe functioning), the performance of the subgroups of patients is plotted as a scaled score in which the mean and standard deviation of the control group are equivalent to 100 and 10, respectively. Accordingly, a scaled score of 100 is equivalent to the mean of the control group while a scaled score of 80 signifies a level of performance that falls 2 standard deviations below the control group mean.

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    Neuroimaging in Case 20 (see Table 1). The magnetic resonance images (MRI's) in C, D, and E were spin-echo images obtained at a relaxation time (TR) of 2000 msec and an echo delay time (TE) of 60 msec. A: Computerized tomography (CT) scan on admission (day of injury) at the level of the lateral ventricle bodies. The scan was interpreted as normal. B: Baseline CT scan obtained 5 days after injury showing a left frontal lesion, seen as an area of mixed low and high density. C: Baseline MRI obtained 5 days after injury at the identical level as the CT scan shown in B. A left frontal lesion with heterogeneous signal intensity is disclosed indicating isointense and hyperintense areas relative to the brain. D and E: Magnetic resonance images obtained 1 month (D) and 3 months (E) postinjury showing resolution of the left frontal lesion.

References

  • 1.

    Benton AL: Differential behavioral effects in frontal lobe disease. Neuropsychologia 6:53601968Benton AL: Differential behavioral effects in frontal lobe disease. Neuropsychologia 6:53–60 1968

    • Search Google Scholar
    • Export Citation
  • 2.

    Benton ALHamsher K: Manual for the Multilingual Aphasia Examination. Iowa City: University of Iowa1978Benton AL Hamsher K: Manual for the Multilingual Aphasia Examination. Iowa City: University of Iowa 1978

    • Search Google Scholar
    • Export Citation
  • 3.

    Buschke HFuld PA: Evaluating storage, retention, and retrieval in disordered memory and learning. Neurology 24:101910251974Buschke H Fuld PA: Evaluating storage retention and retrieval in disordered memory and learning. Neurology 24:1019–1025 1974

    • Search Google Scholar
    • Export Citation
  • 4.

    Bydder GMSteiner REYoung IRet al: Clinical NMR imaging of the brain: 140 cases. AJR 139:2152361982Bydder GM Steiner RE Young IR et al: Clinical NMR imaging of the brain: 140 cases. AJR 139:215–236 1982

    • Search Google Scholar
    • Export Citation
  • 5.

    Eisenberg HM: Outcome after head injury: general considerations and neurobehavioral recovery. Part I. General considerations in Becker DPPovlishock JT (eds): Central Nervous System Trauma Status Report. Bethesda: National Institute of Neurological and Communicative Disorders and Stroke1985 pp 271280Eisenberg HM: Outcome after head injury: general considerations and neurobehavioral recovery. Part I. General considerations in Becker DP Povlishock JT (eds): Central Nervous System Trauma Status Report. Bethesda: National Institute of Neurological and Communicative Disorders and Stroke 1985 pp 271–280

    • Search Google Scholar
    • Export Citation
  • 6.

    Gandy SESnow RBZimmerman RDet al: Cranial nuclear magnetic resonance imaging in head trauma. Ann Neurol 16:2542571984Gandy SE Snow RB Zimmerman RD et al: Cranial nuclear magnetic resonance imaging in head trauma. Ann Neurol 16:254–257 1984

    • Search Google Scholar
    • Export Citation
  • 7.

    Gennarelli TASpielman GMLangfitt TWet al: Influence of the type of intracranial lesion on outcome from severe head injury. A multicenter study using a new classification system. J Neurosurg 56:26321982Gennarelli TA Spielman GM Langfitt TW et al: Influence of the type of intracranial lesion on outcome from severe head injury. A multicenter study using a new classification system. J Neurosurg 56:26–32 1982

    • Search Google Scholar
    • Export Citation
  • 8.

    Gomori JMGrossman RIGoldberg HIet al: Intracranial hematomas: imaging by high-field MR. Radiology 157:87931985Gomori JM Grossman RI Goldberg HI et al: Intracranial hematomas: imaging by high-field MR. Radiology 157:87–93 1985

    • Search Google Scholar
    • Export Citation
  • 9.

    Gronwall DWrightson P: Cumulative effect of concussion. Lancet 2:9959971975Gronwall D Wrightson P: Cumulative effect of concussion. Lancet 2:995–997 1975

    • Search Google Scholar
    • Export Citation
  • 10.

    Gronwall DWrightson P: Delayed recovery of intellectual function after minor head injury. Lancet 2:6056091974Gronwall D Wrightson P: Delayed recovery of intellectual function after minor head injury. Lancet 2:605–609 1974

    • Search Google Scholar
    • Export Citation
  • 11.

    Han JSKaufman BAlfidi RJet al: Head trauma evaluated by magnetic resonance and computed tomography: a comparison. Radiology 150:71771984Han JS Kaufman B Alfidi RJ et al: Head trauma evaluated by magnetic resonance and computed tomography: a comparison. Radiology 150:71–77 1984

    • Search Google Scholar
    • Export Citation
  • 12.

    Holbourn AHS: Mechanics of head injuries. Lancet 2:4384411943Holbourn AHS: Mechanics of head injuries. Lancet 2:438–441 1943

  • 13.

    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
  • 14.

    Jones-Gotman MMilner B: Milner B: Design fluency: the invention of nonsense drawings after focal cortical lesions. Neuropsychologia 15:6536741977Jones-Gotman M Milner B: Design fluency: the invention of nonsense drawings after focal cortical lesions. Neuropsychologia 15:653–674 1977

    • Search Google Scholar
    • Export Citation
  • 15.

    Kraus JFBlack MAHessol Net al: The incidence of acute brain injury and serious impairment in a defined population. Am J Epidemiol 119:1962011984Kraus JF Black MA Hessol N et al: The incidence of acute brain injury and serious impairment in a defined population. Am J Epidemiol 119:196–201 1984

    • Search Google Scholar
    • Export Citation
  • 16.

    Langfitt TWObrist WDAlavi A: Alavi A: Regional structure and function in head-injured patients: correlation of CT, MRI, PET, CBF, and neuropsychological assessment in Levin HSEisenberg HMGrafman J (eds): Neurobehavioral Recovery from Head Injury. New York: Oxford University Press (In press 1987)Langfitt TW Obrist WD Alavi A: Regional structure and function in head-injured patients: correlation of CT MRI PET CBF and neuropsychological assessment in Levin HS Eisenberg HM Grafman J (eds): Neurobehavioral Recovery from Head Injury. New York: Oxford University Press (In press 1987)

    • Search Google Scholar
    • Export Citation
  • 17.

    Levin HSHigh WM JrGoethe KEet al: The neurobehavioral rating scale: assessment of the behavioral sequelae of head injury by the clinician. J Neurol Neurosurg Psychiatry (In press1987)Levin HS High WM Jr Goethe KE et al: The neurobehavioral rating scale: assessment of the behavioral sequelae of head injury by the clinician. J Neurol Neurosurg Psychiatry (In press 1987)

    • Search Google Scholar
    • Export Citation
  • 18.

    Levin HSLarrabee GJ: Disproportionate decline in visuospatial memory in human aging. Soc Neurosci Abstr 9:9181983 (Abstract)Levin HS Larrabee GJ: Disproportionate decline in visuospatial memory in human aging. Soc Neurosci Abstr 9:918 1983 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 19.

    Levin HSMattis SRuff RMet al: Neurobehavioral outcome following minor head injury: a three-center study. J Neurosurg 66:2342431987Levin HS Mattis S Ruff RM et al: Neurobehavioral outcome following minor head injury: a three-center study. J Neurosurg 66:234–243 1987

    • Search Google Scholar
    • Export Citation
  • 20.

    Levin HSO'Donnell VMGrossman RG: The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis 167:6756841979Levin HS O 'Donnell VM Grossman RG: The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis 167:675–684 1979

    • Search Google Scholar
    • Export Citation
  • 21.

    Nelson HE: A modified card sorting test sensitive to frontal lobe defects. Cortex 12:3133241976Nelson HE: A modified card sorting test sensitive to frontal lobe defects. Cortex 12:313–324 1976

    • Search Google Scholar
    • Export Citation
  • 22.

    Rimel RWGiordani BBarth JTet al: Disability caused by minor head injury. Neurosurgery 9:2212281981Rimel RW Giordani B Barth JT et al: Disability caused by minor head injury. Neurosurgery 9:221–228 1981

    • Search Google Scholar
    • Export Citation
  • 23.

    Rimel RWGiordani BBarth JTet al: Moderate head injury: completing the clinical spectrum of brain trauma. Neurosurgery 11:3443511982Rimel RW Giordani B Barth JT et al: Moderate head injury: completing the clinical spectrum of brain trauma. Neurosurgery 11:344–351 1982

    • Search Google Scholar
    • Export Citation
  • 24.

    Snow RBZimmerman RDGandy SEet al: Comparison of magnetic resonance imaging and computed tomography in the evaluation of head injury. Neurosurgery 18:45521986Snow RB Zimmerman RD Gandy SE et al: Comparison of magnetic resonance imaging and computed tomography in the evaluation of head injury. Neurosurgery 18:45–52 1986

    • Search Google Scholar
    • Export Citation
  • 25.

    Spetzler RFZabramski JMKaufman B: Clinical role of magnetic resonance imaging in the neurosurgical patient. Neurosurgery 16:5115241985Spetzler RF Zabramski JM Kaufman B: Clinical role of magnetic resonance imaging in the neurosurgical patient. Neurosurgery 16:511–524 1985

    • Search Google Scholar
    • Export Citation
  • 26.

    Teasdale GJennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81841974Teasdale G Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–84 1974

    • Search Google Scholar
    • Export Citation
  • 27.

    Zimmerman RABilaniuk LTGrossman RIet al: Resistive NMR of intracranial hematomas. Neuroradiology 27:16201985Zimmerman RA Bilaniuk LT Grossman RI et al: Resistive NMR of intracranial hematomas. Neuroradiology 27:16–20 1985

    • Search Google Scholar
    • Export Citation

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