patient with only brain stem function prognosis

The DAI is the exact pathological basis, presenting together with or without hemorrhage extending into ventricle, basal ganglia, corpus callosum, and subarachnoid space which are presumably caused by diffuse shearing injury.

The classical DAI typically occurs after head impact and render the victims unconscious at the moment of impact. 1) addressed diffuse brain damage of immediate impact type which strongly correlates DAI to focal lesions in dorsolateral quadrant of the brain stem, there had been so much controversy regarding the existence of primary brain stem injury in isolation without any other pathology in blunt head injury 19). In addition to that, all impacts to the neck, although few in numbers, was known to give primary brain stem lesions 7). This clinical evidence was well verified in animal study using fluid percussion injury model under the hypothesis that the cerebellum is susceptible to selective Purkinje cell loss as well as white matter dysfunction 22). But, another supportive review showed a preponderance of occipital impacts among the cases with primary brain stem lesions which were associated with cerebellar contusion, laceration, and hemorrhage. In terms of cranial impact site, literature reviews addressed there is an association between occipital blows and primary cerebellar and brain stem lesions 6, 37). According to TBSI case reports to date, the frequent site of hemorrhage or contusion site is confined to dorsal side of midbrain 23), cranial nerves 16), whole brain stem 26), cerebellum 22), combined with upper cervical spinal injuries, clinically presenting as hemiparesis 27). For example, an injury of lower brain stem could be caused by hyperextension of the cervical vertebrae or reciprocal actions of fracture of the clivus and the direct effect on the brain stem by acceleration or rotational forces 26). These lesions are considered to result from the shearing mechanism in and around the brain stem very close to the tentorial edge. Nervous and/or vascular compression against the tentorial notch mostly occurs at its lateral portion due to the shortest distance to the brain stem and near the level of pontomesencephalic junction. The resultant outcome was conveniently evaluated with two categories the first was GCS as an early prognosticator and the second was GOS as a late one at the 6 months after trauma.

2), Type 2 injury associated with supratentorial mass lesions (Type 3). 1), TSAH with TBSI as a form of diffuse axonal injury (Type 2)( Fig. The second was five injury parameters which were mode of injury (high speed, traffic injury and low speed, non-traffic injury), presence of combined injury, impact site on scalp (supratentorial and infratentorial), presence of skull fracture, and lastly the radiologic findings which showed three kinds of pattern : traumatic subarachnoid hemorrhage (TSAH) alone around interpedunculo-ambient cistern (Type 1) ( Fig. The first was demographic one such as age and gender. Arbitrarily, the clinical parameters were classified as two categories. p-values less than 0.05 were considered as statistically significant for all measures.Īll patients had CT study performed on admission and, in selected cases, MR imaging studies were done to characterize several variables involved in TBSI with special reference to correlation among various parameters on patients' prognosis. The chi square test was used for the univariate analysis and logistic regression model was used for the multivariate analysis. Initially, the correlation was analyzed among seven clinical variables using univariate and multivariate analyses. The correlation was analyzed among seven clinical variables (age, gender, mode of injury, combined injury, impact site on scalp, radiologic finding inclusive of skull fracture), which were reflected on GCS as an early prognosticator and GOS as a late one. The exclusion criteria for data selection in this study were episode of shock state, history of alcohol intoxication, episode of blood dyscrasia, and previous history of head injury. In case of outpatient and the rest of patients, follow-up records were reviewed and telephone interviews were used. The data were retrospectively collected from the clinical records of 136 TBSI cases among consecutive 2695 head-injured patients who had admitted from January 2004 to December 2008.

Patient with only brain stem function prognosis