Cases Of Diffuse Axonal Injury Research Articles

Considerations on cases of diffuse axonal injury autopsied in the Institute of Forensic Medicine Iasi, Romania

Considerations on cases of diffuse axonal injury autopsied in the Institute of Forensic Medicine Iasi, Romania

TO ASSESS VARIOUS BRAIN LESIONS ON MRI

Background- The danger of intracranial pathology is that expansion in an enclosed space leads to brain compression causing ischemia, swelling and loss of function that can be permanent and possibly fatal.
 Methods- This was a simple observational prospective study carried out at the Department Of Radio-Diagnosis And Modern Imaging, S.P.M.C. & A.G. Of P.B.M. Hospitals, Bikaner. All the patients presented for MR brain study with some neurological complaints and showed positive findings on MRI were included in this study.
 Results- out of total 120 stroke cases, there were 33 cases of acute arterial infarct, 4 of HIE, 6 cases of ICH, 76 of subacute arterial infarct and 1 case of venous infarct. Similarly, out of total 17 cases of tumors, 9 cases were of meningioma, 4 of lymphoma, 2 of glioma and metastasis each. Out of total 9 cases of infections, there were 3 cases of abscess, 2 of encephalitis and 4 of tubercular meningitis. There were 1 case of pontine myelinolysis, 2 cases of ADEM and 1 cases of diffuse axonal injury in this study.
 Conclusion- Stroke comprised the majority of lesions at 120 cases (80% of the total cases studied).
 Keywords: MRI, Brain, lesion.

The efficacy of magnesium sulfate administration in diffuse axonal injury cases

The efficacy of magnesium sulfate administration in diffuse axonal injury cases

GCS score and MRI grading does not predicts the outcome in dai patients - a prospective study

Abstract Diffuse axonal injury (DAI) is a type of brain injury due to extensive lesions in white matter tract occurring over a wide area. It is one of the most common and devastating types of traumatic brain injury and major cause of unconsciousness and persistent vegetative state after head trauma. DAI occurs in about half of all cases of severe head trauma. The study was undertaken to correlate the GCS at time of admission and Grade of DAI with the outcome. Aim: - To correlate GCS Score and MRI grading with the outcome in DAI patients. Setting and Design: - A 3 months prospective study was conducted in Department of Neurosurgery. Material and Method: - Sources of Data: - Patients admitted with clinical diagnosis of Diffuse Axonal Injury under Department of Neurosurgery. Sample size: - 50 cases of Diffuse Axonal Injury. Inclusion Criteria: - All traumatic DAI Patients requiring ICU care. Exclusion Criteria: - Head injury patients requiring Surgery. Patients other findings on imaging as contusion, EDH, SDH, IVH.Patients with Sepsis. Patients with other co morbid Illness as DM, Hypertension. Patients who were haemodynamically unstable at the time of admission. Patients with other systemic injuries. Statistical Analysis. Data so collected was analysed using IBM SPSS Statistics Windows, version 20.0 (Armonk, NY: IBM Corp) for the generation of descriptive and inferential statistics. The statistical significant difference among age groups was determined by Chi square test and one way analyses of variance. The level of significance was set at p˂0.05. Results: Distribution of patients according to Gender and MRI Grading shown in Table 1. Total 50 patients were evaluated out of which 38 (76%) were male and 12 (24%) were female. Number of patients according to Grading [Table 2 and Fig. 1] Out of 50 patients admitted 10% (5) constitutes Grade 1 DAI, 28% (14) grade II, and 62% (31) Grade III. Grades of DAI according to age of patients [Table 3]. Mean age in Grade I patients was 20.83±3.63, Grade II 23.36±7.089 and in Grade III 22.32±11.38. Comparisons of Mean ICU stay Mean Hospital stay and Mortality in Different GCS Groups [Table 4]. In patients with GCS 3-8 the mean ICU stay was 18.48±14.53, mean hospital stay was 37.24±12.31 and Mortality was 15.21%, in patients with GCS 9-12, mean ICU stay was 10.5±4.12, Hospital stay 19.4±5.79 and mortality was 25%. Comparison of Mean ICU stay, and Ventilator stay in different MRI Grade [Table 5]. In patients with Grade I DAI Mean ICU stay was 17.13±14.65 and Mean Ventilator stay was 6.24±2.57, In Grade II DAI mean ICU stay was 20.57±15.45 and Ventilator stay was 12.01±3.82 and in Grade III mean ICU stay was 23.4±15.41 and mean Ventilator stay was 10.89±2.58. Mortality of patients in different Grades and GCS groups [Table 6 and Fig 2] In patients with GCS 9-12 and Grade III only 1 patient died, while in patients with GCS 3- 8 total 7 died, 2 in Grade I, 2 in Grade II and 3 in Grade III. Complications [Table 7] Out of 5 patients in Grade I, electrolyte imbalance was seen in 1 patient in the form of hypernatraemia, 1 patient developed seizure, and septicaemia was seen in 1 and 1 patient developed shock. In patients with Grade II DAI out of 14 patients 1 had ventilator associated pneumonia, hypernatraemia was seen in 1, 1patient developed bed sore, seizures seen in 3, 2 had septicaemia & shock was seen in 2, and in 1drug reaction occurred. Out of 31 patients with Grade III DAI 2 developed ventilator associated pneumonia, hypernatraemia and hyponatraemia was seen in 2 & 1 patient respectively, 2 developed bedsore, seizure in 1 and septicaemia and shock was seen in 3-3 patients. Conclusion:-Diffuse axonal injury is a very common finding in traumatic head injury patients. Magnetic resonance imaging and GCS scoring does not have appropriate prognostic value in pure DAI patients and a better survival rate can be achieved with dedicated neurocritical care and neurosurgical management.

Correlation Between Brain Imaging and Glasgow Coma Scale in Traumatic Head Injury in Pediatrics

Objectives: The aim of this work is to study the relationship between the initial GCS and admission brain CT findings and MRI brain findings if indicated in head trauma patients at pediatric age group. Background: Trauma is a leading cause of death in children older than 1 year, with head trauma representing 80% or more of the injuries. In approximately 5% of head trauma cases, patients die at the site of the accident. Head trauma has a high emotional, psychosocial and economic impact because these patients often have comparatively long hospital stays. Methods: This prospective study included 100 patients with head trauma at pediatric age group; the patients were evaluated with respect to their initial GCS and admission brain CT findings and correlated with clinical data. Some patients were further evaluated with MRI of brain when needed. Results: Male to female ratio was 73:27, their ages ranged from 1 day to 18 years with a mean age of 9.1 years. Of the 100 cases included in this study 21 cases were with normal CT examination and 79 were with abnormal imaging findings. 54% of the cases classified as mild TBI, 8% of the cases classified as moderate TBI and 38% of the cases classified as severe TBI. Imaging findings such as subgaleal hematoma, skull fractures, subarachnoid hemorrhage, cerebral contusion, intracerebral hemorrhage, extra-axial blood collection and diffuse cerebral edema were observed in 79% of the patients. Conclusion: Statistical significance was observed between GCS and the imaging findings, the lower the GCS score, the more severe were the TBI and imaging findings. MRI has been shown to be superior to CT in the detection of non-hemorrhagic brain injury and cases of diffuse axonal injury.

Six cases of diffuse axonal injury with maxillofacial injury

Six cases of diffuse axonal injury with maxillofacial injury

Brain MR diffusion tensor imaging and fibre tracking to differentiate between two diffuse axonal injuries

We report here two cases of diffuse axonal injury (DAI) studied by MR diffusion tensor imaging (DTI) and fibre tracking (FT) focused on the corpus callosum. In one case, DTI and FT pattern matched the diagnosis of broken white matter tracts. In the other case there was a discrepancy between DTI and FT data that showed unaltered white matter tracts with the presence of intra-cellular oedema. These data suggested that DTI and FT are able to differentiate between traumatic cytotoxic oedema and broken fibres in the case of DAI.

Pathological study of diffuse axonal injury patients who died shortly after impact.

It is generally considered that axonal injury is apparent only on electron microscopy in the very early stage after a closed head injury. To clarify the pathological findings in head injury patients dying very shortly after the impact, we analyzed 8 fatal cases of diffuse axonal injury (DAI) who underwent medicolegal autopsy at the Department of Forensic Medicine of Kyoto Prefectural University of Medicine. Seven cases died within one hour after injury and another one case died 3 days after injury. We studied these cases macroscopically, microscopically, and electron microscopically. Macroscopically all cases showed the typical findings of diffuse axonal injury. Microscopical study of the cases who died within one hour revealed no characteristic findings of DAI such as appearance of retraction balls or microglia. On the other hand, in the case who died only 3 days after injury it showed the typical retraction balls. Electron microscopic study showed the remarkable destruction of cytoskeletal structure of axons in all cases. From our results, it is reasonable to speculate that DAI may be common among head injury patients who die very soon after the impact.

Diffuse axonal injury in head injuries caused by a fall.

82 cases of diffuse axonal injury were found at necropsy in 635 patients with fatal nonmissile head injuries. 13 of these injuries were attributable to falls, and in all the patients fell from a considerable height. Diffuse axonal injury was not found in those with head injuries caused by a simple fall--ie, a fall from not more than the person's own height--but there was a statistically significant association between the presence of diffuse axonal injury and falls from a considerable height. These results indicate that diffuse axonal injury rarely, if ever, occurs as a result of a fall unless the patient has fallen some distance.

Diffuse axonal injury due to nonmissile head injury in humans: an analysis of 45 cases.

Forty-five cases of diffuse axonal injury (DAI) brought about by nonmissile head injury in humans are analyzed and compared with 132 cases of fatal head injury without DAI. All cases were subjected to a comprehensive neuropathological study. In the patients with DAI a statistically significant lower incidence of lucid interval, fracture of the skull, cerebral contusions, intracranial hematoma, and evidence of high intracranial pressure were found, with a higher incidence of head injury due to road traffic accident. Brain swelling and hypoxic brain damage were not statistically different in the two groups. The features of DAI in humans are compared with the DAI that has been produced in subhuman primates by pure inertial loading brought about by angular acceleration of the head. The available evidence indicates that DAI in human beings occurs at the time of head injury and is not due to complicating factors such as hypoxia, brain swelling, or raised intracranial pressure.