Lesions in deep gray nuclei after severe traumatic brain injury predict neurologic outcome.

Thomas Tourdias,Frédéric Clarençon,Nicolas Menjot De Champfleur,Éric Bardinet,Gustavo Soto-Ares,Vincent Pelbarg,Damien Galanaud, ,Jérome Yelnik,Vincent Degos,Didier Dormont,Rajiv Gupta,Emmanuelle Schmitt,Danielle Ibarrola,Eléonore Tollard,Jacques Martinerie,Louis Puybasset

doi:10.1371/journal.pone.0186641

Abstract

PurposeThis study evaluates the correlation between injuries to deep gray matter nuclei, as quantitated by lesions in these nuclei on MR T2 Fast Spin Echo (T2 FSE) images, with 6-month neurological outcome after severe traumatic brain injury (TBI).Materials and methodsNinety-five patients (80 males, mean age = 36.7y) with severe TBI were prospectively enrolled. All patients underwent a MR scan within the 45 days after the trauma that included a T2 FSE acquisition. A 3D deformable atlas of the deep gray matter was registered to this sequence; deep gray matter lesions (DGML) were evaluated using a semi-quantitative classification scheme. The 6-month outcome was dichotomized into unfavorable (death, vegetative or minimally conscious state) or favorable (minimal or no neurologic deficit) outcome.ResultsSixty-six percent of the patients (63/95) had both satisfactory registration of the 3D atlas on T2 FSE and available clinical follow-up. Patients without DGML had an 89% chance (P = 0.0016) of favorable outcome while those with bilateral DGML had an 80% risk of unfavorable outcome (P = 0.00008). Multivariate analysis based on DGML accurately classified patients with unfavorable neurological outcome in 90.5% of the cases.ConclusionLesions in deep gray matter nuclei may predict long-term outcome after severe TBI with high sensitivity and specificity.

Highlights

Deep gray matter (DGM) consists of the bilateral thalami and several gray matter nuclei regrouped under the name basal ganglia (BG)
Multivariate analysis based on DGM lesions (DGML) accurately classified patients with unfavorable neurological outcome in 90.5% of the cases
Our study focused on the following deep grey nuclei: CN, thalamus, putamen, globus pallidus (GP), NA, substantia nigra (SN), sub-thalamic nucleus (STN), red nucleus (RN) and zona incerta (ZI) (Fig 2)

Summary

Introduction

Deep gray matter (DGM) consists of the bilateral thalami and several gray matter nuclei regrouped under the name basal ganglia (BG). Several demographic and clinical data, like age, sex (male), Glasgow coma scale (GCS) at admission or pupillary response [2, 3] may influence the neurological outcome in severe TBI. It has been demonstrated that thalamic, corpus callosum and brainstem traumatic lesions are associated with a poor neurological outcome [5, 9]. Traumatic lesions of the DGM are frequent in severe TBI and are found in up to 46% of cases [10]. Multiple case reports and series document lesions in DGM in comatose patients [11,12,13]. Only scant data are available on the influence of DGM lesions (DGML) on the clinical outcome in patients with severe TBI

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