Neuropsychological consequences of two patterns of brain damage shown by MRI in survivors of severe head injury.
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Abstract:
Two subgroups of patients were identified from 48 patients with traumatic head injury who had MRI during the acute stage: (a) those with severe diffuse injury--six patients with lesions in both the corpus callosum and the brain stem; (b) those with severe focal injury--16 patients with extensive frontotemporal lesions. Most patients with diffuse injury were in a coma on admission to hospital, whereas most patients with focal injury were out of coma. Duration of post-traumatic amnesia was prolonged in both groups. Patients were followed up at six months after injury, when a battery of neuropsychological tests was given. Patients with both diffuse and focal patterns of injury were impaired by comparison with controls on a range of measures, including tests of memory and attention. The findings contrast with the view that diffuse injury is of much greater importance than focal injury in determining outcome after head injury.Keywords:
Diffuse axonal injury
Coma (optics)
Diffuse axonal injury is one of the most important types of brain damage that can occur in the course of a head injury. Its presence can usually be predicted post-mortem because of the presence of focal macroscopic abnormalities in the corpus callosum and in the brain stem. This report describes nine cases where the diagnosis could only be made on the basis of histological studies.
Diffuse axonal injury
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The decision as to whether to perform a CT examination of the brain in patients with a Glasgow coma score of 15 after injury is often difficult, given the limited CT scanning facilities available in state hospitals. A retrospective evaluation of 100 consecutive head-injury patients presenting with a Glasgow coma score of 15 at Tygerberg Hospital was therefore carried out. In a surprisingly high number of patients (50%) abnormal findings due to the injury were detected. Analysis of the clinical history parameters did not demonstrate a significant association with abnormal CT findings. It is therefore concluded that brain CT examination in patients with a Glasgow coma score of 15 is justified and that the Glasgow coma scale is a poor predictor of intracranial injury.
Coma (optics)
Head trauma
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Background: The aim of the study is to find out the age and sex distribution, modes of head injury and correlate Glasgow Coma Scale with Computed Tomography in patients with head trauma in our center.Methods: A cross-sectional study was performed among 113 patients of acute head trauma presenting to Emergency department of our hospital for three months. The severity of the head injury was assessed on admission by the Glasgow Coma Scale score and categorized as mild, moderate, or severe head injury. Non contrast head computed tomography was obtained. Results: The mean age of patients studied in this study was 35.53 year in males and 32.1 year in female with male to female ratio being 1.86:1. The most common causes of head injury were road-traffic accident 58 (51%), falls 42 (37%) and physical assault 13 (12%). In our present study, 67 (59.3%) of patients had mild head injury, 27 (23.9%) had moderate head injury and 19(16.8%) had severe head injury. Our study shows presence of multiple lesions with depressed bone fracture of skull bone was associated with lower Glasgow Coma Scale. Significant association between Glasgow Coma Scale and computed tomography finding was seen (p<0.001). Conclusions: Glasgow Coma Scale is strongly associated with computed tomography in patients with head injury. Road traffic accident is the commonest mode of injury. Most present with mild head injury.Keywords: Computed tomography; Glasgow coma scale; head injury
Head trauma
Skull fracture
Trauma Center
Coma (optics)
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Background: Intracranial hemorrhage is a complication of head injury. The initial assessment of the consciousness using Glasgow Coma Scale (GCS) shows severity level of head injury since arriving to the hospital. The GCS score is also known to have association with the presence of intracranial bleeding caused by head injury. This finding helps doctor lived in rural area with no facility of computed tomography (CT) scan to predict the intracranial haemorrhage by assessing the level of consciousness correctly using GCS score. Methods: This study is an observational analytic study using a cross-sectional design. The research was conducted in Dr. Moewardi Hospital for 6 months starting from July to October 2020. The population was all patients with head injury and were then examined by CT scan of head. The 61 subjects were established through the inclusion and the exclusion criteria. Results: There were 61 patients in this study. The reliability test of CT-Scan instrument used Kappa-Cohen test which showed the K value of 0.875 with p < 0.001. The finding of moderate-severe head injury (GCS score 3-12) was associated with the increased risk of intracranial bleeding in head CT scan by 20.70 (5.58-76.77) times significantly higher (p < 0.001). Conclusion: There is significant relationship between the patient's level of consciousness represented by Glasgow Coma Scale (GCS) and the intracranial bleeding based on the head CT scan in the patients with head injuries
Glasgow Outcome Scale
Level of consciousness
Head trauma
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Background: We prospectively investigated whether the number of traumatic lesions detected by magnetic resonance imaging correlated with the level of intracranial pressure (ICP) and outcome among patients with diffuse axonal injury (DAI). Materials: We prospectively studied 19 patients with closed head injuries who were admitted to the Critical Care and Trauma Services at our medical center and who fulfilled the following criteria: did not recover to a Glasgow Coma Scale score greater than 8 after impact, without fixed dilated pupils, and with initial computed tomography findings compatible with DAI. All subjects (n = 19) underwent ICP monitoring for at least 4 days, and T2*-gradient echo imaging was performed within 4 weeks of the impact. Results: A significantly positive correlation was found between the number of lesions detected by magnetic resonance imaging and maximum ICP. The average Glasgow Coma Scale in the good outcome group (Glasgow Outcome Scale IV and V, n = 8) was significantly greater than that in the poor outcome group (Glasgow Outcome Scale I–III, n = 11). The average maximum ICP and the number of lesions in the good outcome group were significantly less than those in the poor outcome group. Conclusion: The number of lesions detected by T2*-gradient echo imaging correlates with the degree of intracranial hypertension and outcome in DAI.
Diffuse axonal injury
Glasgow Outcome Scale
Intracranial pressure monitoring
Coma (optics)
Trauma Center
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Background S-100, a protein of astroglial cells, is described as a marker for central nervous system damage. The aim of this study was to evaluate whether the marker could give information about the severity and possibility of functional recovery after minor and severe head injury. Methods Thirty patients after severe head injury (Glasgow Coma Scale score <9) and 11 patients after minor head injury (Glasgow Coma Scale score > 12) were included. In each case, blood samples were drawn within 6 hours after injury. Outcome was estimated at hospital discharge using the Glasgow Outcome Scale. Results All patients who sustained minor head injury had reached a favorable outcome by the time they were discharged from the hospital. Their mean S-100 serum level was 0.35 [micro sign]g/L. Patients who sustained severe head injury and were classified as having an unfavorable outcome (31%) showed a mean serum concentration of 4.9 [micro sign]g/L, whereas patients classified as having a favorable outcome (69%) had a mean S-100 level of 1.2 [micro sign]g/L. All groups differed significantly (p < 0.05) Conclusion S-100 appears to be a promising marker for the severity of head injury and neuronal damage.
Glasgow Outcome Scale
Brain damage
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BACKGROUND:
To analyse the clinical, radiological and autopsy features of Diffuse Axonal Injury in severe head injury patients.
MATERIAL AND METHODS:
The patients who are admitted to the neurosurgical ward with Severe Head Injury (GCS < 8) and a CT scan suggestive of diffuse axonal injury will be included in the study. The demographic data will be collected and the radiologic features will be analyzed. The patients who die during the course of treatment will be included in the study and the autopsy will be done to study the features of diffuse injury in the brain.
RESULTS:
In patients with diffuse axonal injury, GCS less than 5 , clinical grading 3 have mostly expired.Even with normal CT brain patients with diffuse axonal injury had histopathological changes
CONCLUSION:
Patients with diffuse axonal injury have demonstrable histopathological changes.
Diffuse axonal injury
Grading (engineering)
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PURPOSE To assess the prevalence of MR evidence for diffuse axonal injury at 1.5 T in patients with normal head CT findings after mild head injury. METHODS Twenty consecutive patients with mild head injury (Glasgow Coma Scale, 13 to 15; no subsequent deterioration, loss of consciousness RESULTS The readers agreed that abnormalities compatible with diffuse axonal injury were present in the white matter of 6 (30%) of 20 patients (95% confidence interval, 12% to 54%). Both readers agreed that foci of high signal intensity were present on the T2-weighted spin-echo sequence in 3 (15%) of the 20 cases (95% confidence interval, 3% to 38%) and that foci of hypointensity compatible with hemorrhagic shear injury were present on the T2*-weighted sequence in 4 (20%) of the 20 patients (95% confidence interval, 6% to 44%). Both types of abnormality were noted by the readers in one patient. CONCLUSIONS MR shows evidence of diffuse axonal injury in some patients with normal head CT findings after mild head injury. These lesions may represent the pathologic substrate underlying the postconcussion syndrome that occurs in many patients with moderate to severe head injury.
Diffuse axonal injury
Head trauma
Coma (optics)
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Head injury patients admitted under neurosurgery department at Igmc shimla were taken, who meet the inclusion criteria. GCS Score at the time of arrival in Emergency department taken. Severity of head injury assessed and patients are categorised accordingly, Followed by assessment of Glasgow outcome scale at discharge and 2 months interval. The percentage of patients with Good Recovery as GOS was 27% (27/100) and with Moderate/Severe disablement was 67%(67/100) and 6%(6/100) patients died on 2 month follow up. Out of the 100 patients who participated in this study, 60 Were of severe head injury status according to scoring system i.e. GCS score of 8 or less. The remaining 35 patients were of moderate brain injury (GCS of 9-12) as And 5 patients of mild head injury. On comparing the individual component of GCS, it was found that verbal component was most significant in assessing outcome of the patient.
Glasgow Outcome Scale
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