J Korean Soc Emerg Med.
1999 Jun;10(2):256-265.
Analysis of CT findings in patients with Diffuse Axonal Injury
Abstract
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BACKGROUND: Diffuse axonal injury(DAI) occurring in almost in half of severely head-injured patients is a severe farm of primary brain damage, and is associated with immediate prolonged coma. This study was designed to investigate the brain computerized tomography(CT) findings and prognostic factors of patients with DAI to provide some valuable guidlines in evaluation and management.
METHOD: A series of 71 patients of DAI diagnosed with CT and magnetic resonance imaging(MRI) between January 1996 to December 1997 were studied retrospectively. Inclusion criteria were severe head injury patients of GCS below 8 and whose CT scan demonstrated characteristic punctuate hemorrhage of <20mm in diameter at deep white marrer, basal ganglia, corpus callosum and upper brainstem, and intraventricular hemorrhage. We analyzed data with t-test and regression methods for statistical significance.
RESULT: The lesions on CT were classified according to the modified Adams staging as follows, staging 0 : no lesion identified(25 cases, 35.2%), stage 1 : lesions confined to deep white matter or basal ganglia(32 cases, 45.2%) ; stage 2 : lesions in the corpus callosum(9 cases, 12.7%) ; stage 3 : focal lesions in the corpus callosum and rostral brainstem(5 cases,7.0%). A moderate or good recovery at discharge was achieved by 42 patients(59.2%), but 29 patients had a poor outcome(severe disability in 13, vegetative state in 7, and death in 9). The modified Adams staging in patients with DAI was not associated with Gennarelli's neurological grade, Glasgow coma scale(GCS), and outcome. The CT findings associated with visible hemorrhagic lesions, subarachnoid hemorrhage(SAH), or generalized brain swelling in patients with DAI carried poor outcome.
CONCLUSION
The nonhemorrhagic DAI is not detected by Cf. Patient with decreased conscious level and normal brain CT in head injury should be suspected the DAI. The hemorrhagic DAI had worse prognosis than nonhemorrhagic DAI. Prognosis of the patient with CT findings of SAH or generalized brain swelling in DAI was poor.
