Journal of Trauma and Injury

  • 제31권2호
  • /
  • Pages.51-57
  • /
  • 2018
  • /
  • 2799-4317(pISSN)
  • /
  • 2287-1683(eISSN)
대한외상학회 (The Korean Society of Traumatology)
권호 표지
DOI QR코드

DOI QR Code

Clinical Outcomes of Diffuse Axonal Injury According to Radiological Grade

  • Lee, Hak-Jae (Division of Acute Care Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sun, Hyun-Woo (Division of Acute Care Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Jae-Seok (Division of Acute Care Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Nak-Joon (Division of Acute Care Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jung, Yoon-Joong (Division of Acute Care Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Suk-Kyung (Division of Acute Care Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • 투고 : 2018.03.23
  • 심사 : 2018.07.06
  • 발행 : 2018.08.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: Patients with diffuse axonal injury experience various disabilities and have a high cost of treatment. Recent researches have revealed the underlying mechanism and pathogenesis of diffuse axonal injury. This study aimed to investigate the correlation between the radiological grading of diffuse axonal injury and the clinical outcomes of patients. Methods: From January 2011 to December 2016, among 294 patients with traumatic brain injury, 44 patients underwent magnetic resonance imaging (MRI). A total of 18 patients were enrolled in this study except for other cerebral injuries, such as cerebral hemorrhage or hypoxic brain damage. Demographic data, clinical data, and radiological findings were retrospectively reviewed. The grading of diffuse axonal injury was analyzed based on patient's MRI findings. Results: For the most severe diffuse axonal injury patients, prolonged intensive care unit (ICU) stay (p=0.035), hospital stay (p=0.012), and prolonged mechanical ventilation (p=0.030) were observed. However, there was no significant difference in healthcare-associated infection rates between MRI grading (p=0.123). Massive transfusion, initial hemoglobin and lactate levels, and MRI gradings were found to be highly significant in predicting the duration of unconsciousness. Conclusions: This study showed that patients with high grade diffuse axonal injury have prolonged ICU stays and significantly longer hospital stays. Deteriorated mental patients with high energy injuries should be evaluated to identify diffuse axonal injuries by using an appropriate imaging tool, such as MRI. It will be important to predict the duration of consciousness recovery using MRI scans.

키워드

참고문헌

  1. Strich SJ. Diffuse degeneration of the cerebral white matter in severe dementia following head injury. J Neurol Neurosurg Psychiatry 1956;19:163-85. https://doi.org/10.1136/jnnp.19.3.163
  2. Adams JH, Doyle D, Ford I, Gennarelli TA, Graham DI, McLellan DR. Diffuse axonal injury in head injury: definition, diagnosis and grading. Histopathology 1989;15:49-59. https://doi.org/10.1111/j.1365-2559.1989.tb03040.x
  3. Meythaler JM, Peduzzi JD, Eleftheriou E, Novack TA. Current concepts: diffuse axonal injury-associated traumatic brain injury. Arch Phys Med Rehabil 2001;82:1461-71. https://doi.org/10.1053/apmr.2001.25137
  4. Smith DH, Hicks R, Povlishock JT. Therapy development for diffuse axonal injury. J Neurotrauma 2013;30:307-23. https://doi.org/10.1089/neu.2012.2825
  5. Blumbergs PC, Jones NR, North JB. Diffuse axonal injury in head trauma. J Neurol Neurosurg Psychiatry 1989;52:838-41. https://doi.org/10.1136/jnnp.52.7.838
  6. Gennarelli TA, Thibault LE, Adams JH, Graham DI, Thompson CJ, Marcincin RP. Diffuse axonal injury and traumatic coma in the primate. Ann Neurol 1982;12:564-74. https://doi.org/10.1002/ana.410120611
  7. Adams JH. Diffuse axonal injury in non-missile head injury. Injury 1982;13:444-5. https://doi.org/10.1016/0020-1383(82)90105-X
  8. Zheng WB, Liu GR, Li LP, Wu RH. Prediction of recovery from a post-traumatic coma state by diffusion-weighted imaging (DWI) in patients with diffuse axonal injury. Neuroradiology 2007;49:271-9. https://doi.org/10.1007/s00234-006-0187-8
  9. Park SJ, Hur JW, Kwon KY, Rhee JJ, Lee JW, Lee HK. Time to recover consciousness in patients with diffuse axonal injury : assessment with reference to magnetic resonance grading. J Korean Neurosurg Soc 2009;46:205-9. https://doi.org/10.3340/jkns.2009.46.3.205
  10. Kim JH, Sung SK, Cho WH, Choi CH. Disability estimation in the diffuse axonal injury. J Korean Neurotraumatol Soc 2007;3:13-8. https://doi.org/10.13004/jknts.2007.3.1.13
  11. Chelly H, Chaari A, Daoud E, Dammak H, Medhioub F, Mnif J, et al. Diffuse axonal injury in patients with head injuries:an epidemiologic and prognosis study of 124 cases. J Trauma 2011;71:838-46. https://doi.org/10.1097/TA.0b013e3182127baa
  12. Abu Hamdeh S, Marklund N, Lannsjo M, Howells T, Raininko R, Wikstrom J, et al. Extended anatomical grading in diffuse axonal injury using MRI: hemorrhagic lesions in the substantia nigra and mesencephalic tegmentum indicate poor long-term outcome. J Neurotrauma 2017;34:341-52. https://doi.org/10.1089/neu.2016.4426
  13. Jung NK, Jin SC, Choi WI. Prognostic value of computed tomography and gradient-echo magnetic resonance imaging in diffuse axonal injury. J Trauma Inj 2012;25:122-31.
  14. Moen KG, Brezova V, Skandsen T, Haberg AK, Folvik M, Vik A. Traumatic axonal injury: the prognostic value of lesion load in corpus callosum, brain stem, and thalamus in different magnetic resonance imaging sequences. J Neurotrauma 2014;31:1486-96. https://doi.org/10.1089/neu.2013.3258
  15. Mac Donald CL, Dikranian K, Song SK, Bayly PV, Holtzman DM, Brody DL. Detection of traumatic axonal injury with diffusion tensor imaging in a mouse model of traumatic brain injury. Exp Neurol 2007;205:116-31. https://doi.org/10.1016/j.expneurol.2007.01.035
  16. Ashwal S, Babikian T, Gardner-Nichols J, Freier MC, Tong KA, Holshouser BA. Susceptibility-weighted imaging and proton magnetic resonance spectroscopy in assessment of outcome after pediatric traumatic brain injury. Arch Phys Med Rehabil 2006;87(12 Suppl 2):S50-8.

피인용 문헌

  1. Use of Magnetic Resonance Imaging in Acute Traumatic Brain Injury Patients is Associated with Lower Inpatient Mortality vol.11, pp.None, 2021, https://doi.org/10.25259/jcis_148_2021