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Academic literature on the topic 'Diffuse Axonal Injury Head Injury Outcome Traumatic Brain Injury Microbleeds'
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Journal articles on the topic "Diffuse Axonal Injury Head Injury Outcome Traumatic Brain Injury Microbleeds"
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Griffin, Allison D., L. Christine Turtzo, Gunjan Y. Parikh, et al. "Traumatic microbleeds suggest vascular injury and predict disability in traumatic brain injury." Brain 142, no. 11 (2019): 3550–64. http://dx.doi.org/10.1093/brain/awz290.
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Abstract Traumatic microbleeds are small foci of hypointensity seen on T2*-weighted MRI in patients following head trauma that have previously been considered a marker of axonal injury. The linear appearance and location of some traumatic microbleeds suggests a vascular origin. The aims of this study were to: (i) identify and characterize traumatic microbleeds in patients with acute traumatic brain injury; (ii) determine whether appearance of traumatic microbleeds predict clinical outcome; and (iii) describe the pathology underlying traumatic microbleeds in an index patient. Patients presenting to the emergency department following acute head trauma who received a head CT were enrolled within 48 h of injury and received a research MRI. Disability was defined using Glasgow Outcome Scale-Extended ≤6 at follow-up. All magnetic resonance images were interpreted prospectively and were used for subsequent analysis of traumatic microbleeds. Lesions on T2* MRI were stratified based on ‘linear’ streak-like or ‘punctate’ petechial-appearing traumatic microbleeds. The brain of an enrolled subject imaged acutely was procured following death for evaluation of traumatic microbleeds using MRI targeted pathology methods. Of the 439 patients enrolled over 78 months, 31% (134/439) had evidence of punctate and/or linear traumatic microbleeds on MRI. Severity of injury, mechanism of injury, and CT findings were associated with traumatic microbleeds on MRI. The presence of traumatic microbleeds was an independent predictor of disability (P < 0.05; odds ratio = 2.5). No differences were found between patients with punctate versus linear appearing microbleeds. Post-mortem imaging and histology revealed traumatic microbleed co-localization with iron-laden macrophages, predominately seen in perivascular space. Evidence of axonal injury was not observed in co-localized histopathological sections. Traumatic microbleeds were prevalent in the population studied and predictive of worse outcome. The source of traumatic microbleed signal on MRI appeared to be iron-laden macrophages in the perivascular space tracking a network of injured vessels. While axonal injury in association with traumatic microbleeds cannot be excluded, recognizing traumatic microbleeds as a form of traumatic vascular injury may aid in identifying patients who could benefit from new therapies targeting the injured vasculature and secondary injury to parenchyma.
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Karakaya, Dicle, and Ahmet İlkay Işıkay. "A Review of Traumatic Axonal Injury." Acta Medica 52, no. 2 (2021): 102–8. http://dx.doi.org/10.32552/2021.actamedica.467.
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Traumatic brain injury is a major cause of mortality and neurological disability worldwide and varies according to its cause, pathogenesis, severity and clinical outcome. This review summarizes a significant aspect of diffuse brain injuries – traumatic axonal injury – important cause of severe disability and vegetative state. Traumatic axonal injury is a type of traumatic brain injury caused by blunt head trauma. It is defined both clinically (immediate and prolonged unconsciousness, characteristically in the absence of space-occupying lesions) and pathologically (widespread and diffuse damage of axons). Following traumatic brain injury, progressive axonal degeneration starts with disruption of axonal transport, axonal swelling, secondary axonal disconnection and Wallerian degeneration, respectively. However, traumatic axonal injury is difficult to define clinically, it should be considered in patients with Glasgow coma score < 8 for more than six hours after trauma and diffuse tensor imaging and sensitivity-weighted imaging MRI sequences are highly sensitive in its diagnosis. Glasgow coma score at the time of presentation, location and severity of axonal damage are prognostic factors for clinical outcome.
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Javeed, Farrukh, Lal Rehman, Ali Afzal, and Asad Abbas. "Outcome of diffuse axonal injury in moderate and severe traumatic brain injury." Surgical Neurology International 12 (August 3, 2021): 384. http://dx.doi.org/10.25259/sni_573_2020.
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Background: Diffuse axonal injury (DAI) is a common presentation in neurotrauma. Prognosis is variable but can be dependent on the initial presentation of the patient. In our study, we evaluated the outcome of diffuse axonal injury. Methods: This study was conducted at a tertiary care center from September 2018 to December 2019 and included 133 adult patients with moderate or severe head injury (GCS ≤ 12) diagnosed to have the DAI on the basis of MRI. At 3 months, the result was assessed using the Extended Glasgow Outcome Scale (GOS-E). Results: There were a total of 97 (72.9%) males and 36 (27.1%) females with an average age of 32.4 ± 10 years with a mean GCS of 9 at admission. The most common mode of head trauma was road traffic accidents (RTAs) in 51.9% of patients followed by fall from height in 27.1%. Most patients were admitted with moderate traumatic brain injury (64.7%) and suffered Grade I diffuse axonal injury (41.4%). The average hospital stay was 9 days but majority of patients stayed in hospital for ≤ 11 days. At 3 months, mortality rate was 25.6% and satisfactory outcome observed in 48.1% of patients. The highest mortality was observed in the Grade III DAI. Conclusion: We conclude that the severity of the traumatic head injury and the grade of the DAI impact the outcome. Survivors require long-term hospitalization and rehabilitation to improve their chances of recovery.
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Young, Michael J., William R. Sanders, Rose Marujo, Yelena G. Bodien, and Brian L. Edlow. "Return to Work Within Four Months of Grade 3 Diffuse Axonal Injury." Neurohospitalist 12, no. 2 (2022): 280–84. http://dx.doi.org/10.1177/19418744211051459.
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Neuroprognostication following diffuse axonal injury (DAI) has historically relied on neuroimaging techniques with lower spatial resolution and contrast than techniques currently available in clinical practice. Since the initial studies of DAI classification and prognosis in the 1980s and 1990s, advances in neuroimaging have improved detection of brainstem microbleeds, a hallmark feature of Grade 3 DAI that has traditionally been associated with poor neurologic outcome. Here, we report clinical and radiologic data from two patients with severe traumatic brain injury and grade 3 DAI who recovered functional independence and returned to work within 4 months of injury. Importantly, both patients were scanned using 3 Tesla MRI protocols that included susceptibility-weighted imaging (SWI), a technique that provides enhanced sensitivity for detecting brainstem microbleeds. These observations highlight the importance of developing approaches to DAI classification and prognosis that better align with contemporary neuroimaging capabilities.
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Satya, Navamani Gali, Jartarghar Sharad, Sheshadri Sekhar D., V. Nagaraju, and Murthy K.V.V.S.N. "Clinicoradiological Study and Analysis of Diffuse Axonal Injury and its Outcome – An Institutional Experience." International Journal of Toxicological and Pharmacological Research 14, no. 4 (2024): 40–45. https://doi.org/10.5281/zenodo.12794336.
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<strong>Background:</strong> Diffuse axonal injury is also known as traumatic axonal injury, a severe form of traumatic brain injury and known for its severe consequences. The definitive diagnosis of DAI, especially in its early stage, is difficult. DAI represents approximately one-half of all intra axial traumatic lesions. The lesion is the most significant cause of morbidity in patients with traumatic brain injuries, which most commonly result from high-speed motor vehicle accidents, any patient with a closed head injury who will experience extensive loss of consciousness and neurological deficits warrants neuro imaging. DAI typically consists of several focal white matter lesions measuring 1 – 15 mm in a characteristic distribution. <strong>Aim: </strong>Aimof the study is to study the incidence of Diffuse Axonal Injury in Head Injuries; analyze the morbidity and mortality in DAI; predict the outcome concerning Glasgow Scale, CT, and MRI findings. <strong>Methodology: </strong>This is a prospective study consisting of 69 cases of DAI studied over a period from October 2021 to December 2023 in the Department of Neurosurgery, Guntur Medical College / Government General Hospital, Guntur. All the patients were admitted to the acute neurosurgical care unit and a variety of clinical / imaging data were collected and analyzed concerning Mode of injury, Incidence among various age groups, Sex distribution, Post resuscitative Glasgow Coma Scale (After optimization of SBP, SPO2, GRBs.), Findings on CT Scan, MRI grading, The outcome of the patient at discharge and follow up by Glasgow Outcome Scale. The mortality and morbidity were analyzed concerning GCS and CT & MRI. Scan findings. <strong>Results and Conclusion:</strong> DAI constitutes 2.98% of total head injury admissions and 27.70%in severe head injury. MRI is more sensitive compared to CT. Mortality in our series is 40.58%. Most of DAI are due to Road Traffic Accidents. Second and third decade populations are more in DAI (62.32%). Most of them sustained RTA under alcohol influence (77.41% i.e., 48 out of 62 patients). Neurological deficits improved almost completely (over the 1 ½ year to 2 years) and early recovery seen in younger age groups compared to elder age groups. In 27.5% of cases recovery is good as per GCS. The prognosis, morbidity, mortality in DAI can be predicted with GCS and CT scan and MRI findings.
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Lee, Jen-Pei. "Intraparenchymal and Intraventricular Hemorrhage without Mass Effect in Traumatic Coma." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 18, no. 4 (1991): 458–62. http://dx.doi.org/10.1017/s0317167100032157.
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ABSTRACT:A group of 57-head injured patients showing computerized tomographic (CT) findings compatible with “diffuse brain injury” or of the so called “diffuse axonal injury” is analyzed. Thirty-four patients showed intraparenchymal hemorrhage in the CT scan study, 8 intraventricular hemorrhage and 15 patients had both intraparenchymal and intraventricular hemorrhage. Forty percent (23/57) of those with these findings had associated intracranial focal lesions. The deep nuclei are the most common location of intraparenchymal hemorrhage. Signs of brain stem hemorrhage were seen in 9 patients. Forty-nine percent of patients in this series had a good outcome. Old age (>60), abnormal motor response, abnormal eye signs, associated with focal lesions, and evidence of brain stem hemorrhage are reliable prognostic parameters for a grave outcome.
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De Cassia Almeida Vieira, Rita, Regina Marcia Cardoso De Sousa, Wellingson Silva Paiva, et al. "Predicting Outcomes in Patients with Diffuse Axonal Injury: External Validation of the Widely Used Prognostic Instruments." Annali Italiani di Chirurgia 95, no. 3 (2024): 382–90. http://dx.doi.org/10.62713/aic.3510.
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AIM: Accurate prognosis of diffuse axonal injury (DAI) is important in directing clinical care, allocating resources appropriately, and communicating with families and surrogate decision-makers. METHODS: A study was conducted on patients with clinical DAI due to closed-head traumatic brain injury treated at a trauma center in Brazil from July 2013 to September 2015. The objective efficacy of the Glasgow Coma Scale (GCS), Trauma and Injury Severity Scoring system (TRISS), New Trauma and Injury Severity Scoring system (NTRISS), Abbreviated Injury Scale (AIS)/head, Corticosteroid Randomization After Significant Head Injury (CRASH), and International Mission on Prognosis and Analysis of Clinical Trials (IMPACT) models in the prediction of mortality at 14 days and 6-months and unfavorable outcomes at 6 months was tested. RESULTS: Our cohort comprised 95 prospectively recruited adults (85 males, 10 females, mean age 30.3 ± 10.9 years) admitted with DAI. Model efficacy was assessed through discrimination (area under the curve [AUC]), and Cox calibration. The AIS/head, TRISS, NTRISS, CRASH, and IMPACT models were able to discriminate both mortality and unfavorable outcomes (AUC 0.78–0.87). IMPACT models resulted in a statistically perfect calibration for both 6-month outcome variables; mortality and 6-month unfavorable outcome. Calibration also revealed that TRISS, NTRISS, and CRASH systematically overpredicted both outcomes, except for 6-month unfavorable outcome with TRISS. CONCLUSIONS: The results of this study suggest that TRISS, NTRISS, CRASH, and IMPACT models satisfactorily discriminate between mortality and unfavorable outcomes. However, only the TRISS and IMPACT models showed accurate calibration when predicting 6-month unfavorable outcome.
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Skandsen, Toril, Kjell Arne Kvistad, Ole Solheim, Ingrid Haavde Strand, Mari Folvik, and Anne Vik. "Prevalence and impact of diffuse axonal injury in patients with moderate and severe head injury: a cohort study of early magnetic resonance imaging findings and 1-year outcome." Journal of Neurosurgery 113, no. 3 (2010): 556–63. http://dx.doi.org/10.3171/2009.9.jns09626.
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Object In this prospective cohort study the authors examined patients with moderate to severe head injuries using MR imaging in the early phase. The objective was to explore the occurrence of diffuse axonal injury (DAI) and determine whether DAI was related to level of consciousness and patient outcome. Methods One hundred and fifty-nine patients (age range 5–65 years) with traumatic brain injury, who survived the acute phase, and who had a Glasgow Coma Scale (GCS) score of 3–13 were admitted between October 2004 and August 2008. Of these 159 patients, 106 were examined using MR imaging within 4 weeks postinjury. Patients were classified into 1 of 3 stages of DAI: Stage 1, in which lesions were confined to the lobar white matter; Stage 2, in which there were callosal lesions; and Stage 3, in which lesions occurred in the dorsolateral brainstem. The outcome measure used 12 months postinjury was the Glasgow Outcome Scale–Extended (GOSE). Results Diffuse axonal injury was detected in 72% of the patients and a combination of DAI and contusions or hematomas was found in 50%. The GCS score was significantly lower in patients with “pure DAI” (median GCS Score 9) than in patients without DAI (median GCS Score 12; p < 0.001). The GCS score was related to outcome only in those patients with DAI (r = 0.47; p = 0.001). Patients with DAI had a median GOSE score of 7, and patients without DAI had a median GOSE score of 8 (p = 0.10). Outcome was better in patients with DAI Stage 1 (median GOSE Score 8) and DAI Stage 2 (median GOSE Score 7.5) than in patients with DAI Stage 3 (median GOSE Score 4; p < 0.001). Thus, in patients without any brainstem injury, there was no difference in good recovery between patients with DAI (67%) and patients without DAI (66%). Conclusions Diffuse axonal injury was found in almost three-quarters of the patients with moderate and severe head injury who survived the acute phase. Diffuse axonal injury influenced the level of consciousness, and only in patients with DAI was GCS score related to outcome. Finally, DAI was a negative prognostic sign only when located in the brainstem.
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Lang, Dorothy A., Graham M. Teasdale, Peter Macpherson, and Audrey Lawrence. "Diffuse brain swelling after head injury: more often malignant in adults than children?" Journal of Neurosurgery 80, no. 4 (1994): 675–80. http://dx.doi.org/10.3171/jns.1994.80.4.0675.
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✓ A series of 118 patients with diffuse traumatic brain swelling was studied retrospectively in order to compare the clinical findings in children with those in adults, and to determine the occurrence of neurological deterioration and outcome. The computerized tomography (CT) picture of absent third ventricle and basal cisterns was used to identify the cases. Although this condition has been associated with children, we found the same number of children and adults (59 cases each). Secondary deterioration (decline in consciousness, the development of new focal neurological signs, or an increase in intracranial pressure) occurred in 40% of cases and was more common in adults than children. Features that were significantly associated with deterioration were the presence of prolonged coma (> 1 hour) after the injury, CT signs of diffuse axonal injury or subarachnoid hemorrhage, or a recorded episode of hypotension. A moderate or good recovery at 6 months was achieved by 70 patients (59%), but 45 patients had a poor outcome (severe disability in nine, vegetative state in three, and death in 33) and this was often a consequence of secondary deterioration. In three patients, the outcome was not known. The combination of a severe initial injury, secondary insult, and diffuse swelling is associated with a poor outlook, particularly in adults. The CT appearance of diffuse swelling may develop more readily in children because of the lack of cerebrospinal fluid available for displacement. In children, diffuse swelling may have a relatively benign course unless there is a severe primary injury or a secondary hypotensive insult.
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Chaurasia, I. D., and Deepak Rathor. "To assess and analyze the clinical outcome of conservative and operative management of head injury in acute subdural haematoma." IP Indian Journal of Neurosciences 7, no. 2 (2021): 124–28. http://dx.doi.org/10.18231/j.ijn.2021.020.
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Traumatic acute subdural haematoma (SDH) continue to have high mortality & morbidity despite the advent of rapid transportation, CT Scan and Intensive care management. The general surgical procedures for Acute SDH is Craniotomy with removal of haematoma & decompressive craniectomy if necessary. This is a study based in department of surgery. After taking complete history and detailed examination and investigation (CT Scan) was be done. Decision of surgery was be taken by the consultant neurosurgeon of the acute Subdural Haematoma, involvement of aloquent areas and associated other injury of brain.200 patients with head injury who reported at casualty of Gandhi Medical College, and Hamidia Hospital, Bhopal.In our study, Mode of Injury found to be Assault were 20%, Fall were 27% & RTA 53% in Conservative whereas Assault were 06%, Fall were 14% & RTA 80%.The chi-square statistic is 96.3397. The p-value is &#60; 0.00001. The result is significant at p &#60; 0.05. These findings indicate that the thickness/size of acute SDH significantly correlates with the type of management to be done for the patient.Acute subdural haematoma is the major cause of significant morbidity and mortality due to traumatic head injury. Acute subdual haematoma is commonly associated with countercoup injuries and diffuse axonal injury (DAI). The clinical presentation in patients with acute SDH is related to raised ICP and the severity of DAI. C.T. Scan is the investigation of choice in patients with head injury.
Book chapters on the topic "Diffuse Axonal Injury Head Injury Outcome Traumatic Brain Injury Microbleeds"
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Lepage, Christian, Inga K. Koerte, Vivian Schultz, Michael J. Coleman, and Martha E. Shenton. "Traumatic brain injury." In New Oxford Textbook of Psychiatry, edited by John R. Geddes, Nancy C. Andreasen, and Guy M. Goodwin. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198713005.003.0047.
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Traumatic brain injury (TBI) results from blunt trauma, acceleration–deceleration forces, rotational forces, or blast exposure to the head. The injury involves a heterogenous pattern of focal and/or diffuse axonal injury, leading to a wide range of symptoms. The severity of the injury covers the spectrum from mild to moderate to severe, with severe injury leading to possible coma and even death. The range of symptoms, the variability in treatment options, and the prognosis of TBI, as well as the psychosocial implications, make it a complex injury that often calls upon the services of neurosurgeons, neurologists, psychiatrists, psychologists, and rehabilitation specialists to help patients achieve the best possible outcome. This chapter aims to provide an overview of TBI that includes the classification, epidemiology, aetiology, pathophysiology, clinical symptoms, long-term outcome, diagnostic implications, and differential diagnosis, as well as possible treatment options and future directions for research.