Primary Brainstem Injury Research Articles

Assessment of brainstem damage by the auditory brainstem response in acute severe head injury.

In 64 cases suffering from severe head injury (Glasgow coma scale: less than seven- the auditory brainstem responses (FARs) recorded at the vertex, which are thought to be volumet conducted far-field potentials reflecting the sequential electrical activities of the auditory afferen) system in the brainstem, were recorded in the neurosurgical intensive care room immediately after admission. The alterations in the responses were compared with the types of primary injury, neurological signs., CT findings and outcome following treatment. Based on the results obtained, it is concluded that the FAR is a useful indicator for predicting the effects of treatment on brainstem damage in patients with severe head injury, and that it provides more reliable information about the function of the brainstem than the neurological signs or CT findings. Moreover, it also offers a diagnostic method for primary brainstem injury. Three cases or primary brainstem injury without lesions in the supratentorial region were diagnosed by means of combined CT and FAR recording.

Diffuse brain damage of immediate impact type. Its relationship to 'primary brain-stem damage' in head injury.

In a neuropathological analysis of 151 fatal non-missile head injuries, there were 19 cases with focal lesions in the dorsolateral quadrant of the brain-stem in the corpus callosum, and histological evidence of diffuse damage to white matter. Eight of these cases had not experienced a high intracranial pressure during life. All 19 cases had been rendered unconscious at the moment of impact and had remained so or in the persistent vegetative state until death. It is therefore concluded that diffuse damage to white matter may occur as a primary event at the moment of impact, that is, it is one type of immediate impact damage to the brain. It is also concluded that this type of damage is the pathological basis of 'primary brain-stem injury' since in no patient thought clinically to have sustained 'primary brain-stem injury' were abnormalities confined to the brain-stem. Since no patient with this type of brain damage recovered consciousness after injury, it is probable that diffuse damage to white matter is the most important single factor governing the outcome in a patient who sustains a non-missile head injury.

Clinical study of primary brain stem injury (author's transl)

This paper reports an analysis of a series of primary brainstem injury resulted from blunt head trauma. The records of 25 patients with the diagnosis of primary brainstem injury, with decerebration, disturbed consciousness, typical manifestations of brainstem damage with no intracranial hematomas or other severe complications were studied retrospectively. Our purpose is to define some of the factors affecting the prognosis of these patients. The particular factors we have evaluated are the age, the duration of decerebration, recovery time from the disturbed consciousness, other neurological findings and vital signs. Their age varied from 3 to 67 years. Many cases in this series had a blow to the frontal or occipital region as a site of cranial impact. Skull fractures were found in 14 cases (56%). The mortality in this series was 56% (14 cases), 12 cases of which died within 7 days after the trauma. Survived cases were classified by the residual deficits as minimal (2 cases), marked (4 cases) and prolonged coma (5 cases). Since the two cases with minimal deficits were children, it seems that the age of the patients is the most important factors for the prognosis. The average duration of decerebration in the survived cases was 21 days in the cases with marked deficits and 14 days in the cases with minimal one. The duration less than 7 days of decerebrate state was a better prognostic sign than that more than 14 days. Variable levels in the state of consciousness with fluctuations were found in this series. In the cases with marked deficits, mean recovery time was 77 days, whereas in those with minimal ones it was 42 days. It seems the shorter the period of the recovery, the better the prognosis. Variable degrees of pyramidal signs, ocular symptoms or abnormalities in vital signs were seen. The mortality rate was high in the cases with bilateral pyramidal signs, dilated pupils without light reaction, anisocoria and marked fluctuations of vital signs. These seem to be a poor prognostic signs. There was no correlation between the pressure and appearance of cerebrospinal fluid and the quality of survivors. The use of parenteral corticosteroids and tracheostomy were not related to the improvement of the prognosis. It is concluded that the age was one of the most important factors affecting the prognosis of primary brainstem injury, and that the mortality and morbidity were clearly influenced by the duration of decerebration and recovery time from the state of vital signs.

PRIMARY FOCAL IMPACT DAMAGE TO THE BRAINSTEM IN BLUNT HEAD INJURIES DOES IT EXIST ?

Serial blocks of brainstem from 100 fatal, blunt (non-missile) head injuries have been examined histologically. In 7 of the 18 patients in whom intracranial pressure had not increased there were constant abnormalities in the brainstem which could be attributed only to primary-impact injury—namely, lesions in, or adjacent to, one or both superior cerebellar peduncles and degeneration of axons in ascending and descending tracts in the brainstem. In all these 7 patients there was also damage elsewhere in the brain. It is suggested that so-called " primary brainstem injury " does not exist in isolation but is only an aspect of diffuse brain damage.