J Korean Neurosurg Soc.  2013 Aug;54(2):100-106. 10.3340/jkns.2013.54.2.100.

The Usefulness of Brain Magnetic Resonance Imaging with Mild Head Injury and the Negative Findings of Brain Computed Tomography

• Kim DS
• Kong MH
• Jang SY
• Kim JH
• Kang DS
• Song KY

• KMID: 1814245
• DOI: http://doi.org/10.3340/jkns.2013.54.2.100

Abstract

OBJECTIVE
To investigate the cases of intracranial abnormal brain MRI findings even in the negative brain CT scan after mild head injury.
METHODS
During a 2-year period (January 2009-December 2010), we prospectively evaluated both brain CT and brain MRI of 180 patients with mild head injury. Patients were classified into two groups according to presence or absence of abnormal brain MRI finding even in the negative brain CT scan after mild head injury. Two neurosurgeons and one neuroradiologist validated the images from both brain CT scan and brain MRI double blindly.
RESULTS
Intracranial injury with negative brain CT scan after mild head injury occurred in 18 patients (10.0%). Headache (51.7%) without neurologic signs was the most common symptom. Locations of intracranial lesions showing abnormal brain MRI were as follows; temporal base (n=8), frontal pole (n=5), falx cerebri (n=2), basal ganglia (n=1), tentorium (n=1), and sylvian fissure (n=1). Intracranial injury was common in patients with a loss of consciousness, symptom duration >2 weeks, or in cases of patients with linear skull fracture (p=0.00013), and also more frequent in multiple associated injury than simple one (35.7%>8.6%) (p=0.105).
CONCLUSION
Our investigation showed that patients with mild head injury even in the negative brain CT scan had a few cases of intracranial injury. These findings indicate that even though the brain CT does not show abnormal findings, they should be thoroughly watched in further study including brain MRI in cases of multiple injuries and when their complaints are sustained.

Keyword

Mild head injury; Computed tomography; Magnetic resonance imaging

MeSH Terms

Basal Ganglia
Brain
Craniocerebral Trauma
Head
Headache
Humans
Magnetic Resonance Imaging
Magnetics
Magnets
Multiple Trauma
Neurologic Manifestations
Prospective Studies
Skull Fractures
Unconsciousness

Figure

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  Fig. 1 Illustration by magnetic resonance imaging (MRI) compared to computed tomography (CT) in 2 study participants of mild head injury. A 22-year-old male corresponded brain CT (-) and brain MRI (-) group I (A-E) which had no brain CT or MRI parenchymal lesion except extensive scalp swelling (*) of left parieto-occipital area and subgaleal hematoma after mild head injury. A 46-year-old male demonstrated initial brain CT (F) was normal after traffic accident and MRI at post-injury 7 days showed minimal subdural hematoma (arrow) on left temporo-parietal lobe at axial section of T1-weighted image (H) and the hemorrhagic contusion on left frontal lobe (arrow) at axial T2-weighted gradient echo MRI image (J) which corresponded brain CT (-) and brain MRI (+) group II (F-J).

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  Fig. 2 Computed tomography scan showing not abnormal intracranial pathology (A) and T1-weighted MR image showing hemorrhagic contusion (arrow) on left frontal area (B) which was classified as group II.

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  Fig. 3 The numbers of the location of intracranial lesions of the group II.

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