J Korean Neurosurg Soc.  2015 Aug;58(2):131-136. 10.3340/jkns.2015.58.2.131.

Radiologic Determination of Corpus Callosum Injury in Patients with Mild Traumatic Brain Injury and Associated Clinical Characteristics

Affiliations
  • 1Department of Neurosurgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, Korea. painsurgery@gmail.com

Abstract


OBJECTIVE
To investigate the incidence of corpus callosum injury (CCI) in patients with mild traumatic brain injury (TBI) using brain MRI. We also performed a review of the clinical characteristics associated with this injury.
METHODS
A total of 356 patients in the study were diagnosed with TBI, with 94 patients classified as having mild TBI. We included patients with mild TBI for further evaluation if they had normal findings via brain computed tomography (CT) scans and also underwent brain MRI in the acute phase following trauma. As assessed by brain MRI, CCI was defined as a high-signal lesion in T2 sagittal images and a corresponding low-signal lesion as determined by axial gradient echo (GRE) imaging. Based on these criteria, we divided patients into two groups for further analysis : Group I (TBI patients with CCI) and Group II (TBI patients without CCI).
RESULTS
A total of 56 patients were enrolled in this study (including 16 patients in Group I and 40 patients in Group II). Analysis of clinical symptoms revealed a significant difference in headache severity between groups. Over 50% of patients in Group I experienced prolonged neurological symptoms including dizziness and gait disturbance and were more common in Group I than Group II (dizziness : 37 and 12% in Groups I and II, respectively; gait disturbance : 12 and 0% in Groups I and II, respectively).
CONCLUSION
The incidence of CCI in patients with mild TBI was approximately 29%. We suggest that brain MRI is a useful method to reveal the cause of persistent symptoms and predict clinical prognosis.

Keyword

Corpus callosum; Traumatic brain injury; Magnetic resonance imaging; Computed tomography; Glasgow coma scale

MeSH Terms

Brain
Brain Injuries*
Corpus Callosum*
Dizziness
Gait
Glasgow Coma Scale
Headache
Humans
Incidence
Magnetic Resonance Imaging
Prognosis

Figure

  • Fig. 1 Witelson's classification23). The corpus callosum is one of the few white matter tracts that can be discretely identified by conventional MRI. In 1989, Witelson delineated distinct callosal areas in a midsagittal cross-section based on specific mathematical proportions with respect to the anterior (A) and posterior (P) axis. He divided the midsagittal corpus callosum geometrically into segments defined as the following : the anterior third (region I, containing fibers projecting into prefrontal, premotor and supplementary motor regions), anterior midbody (region II, with callosal motor fiber bundles), posterior midbody (region III, with somaesthetic, posterior parietal projections), isthmus (region IV, with posterior parietal, superior temporal projections), and splenium (region V, with the occipital, inferior temporal projections).

  • Fig. 2 MRI and CT images of TBI patient with CCI. A : Upon admission, no abnormal findings are visible on brain CT imaging. B : T2-weighted sagittal MRI revealed a previously unidentified high signal change in region III of the corpus callosum (arrowhead, images captured 3 days following CT imaging). C : Follow-up imaging 3 months after initial MRI depicting a low-density lesion on the body of the corpus callosum (arrowhead, potentially indicating tissue loss following CCI). CCI : corpus callosum injury.


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