Article Figures & Data
Figures
- Fig 1.
Illustrations depicting the different types of brain stem injury observed with subacute MR imaging in severe traumatic brain injury. Gradient-echo T2 images in the axial plane show hemorrhagic (A) (hypointensity indicates foci of hemosiderin deposition) and (B) nonhemorrhagic diffuse axonal injury. On the other hand, axial T2-weighted images demonstrate unilateral (C) and bilateral (D) brain stem traumatic involvement, as well as anterior (E) (contusion) and posterior (F) (diffuse axonal injury) location in the brain stem.
- Fig 2.
Bar graph showing the correlation between MR imaging findings of brain stem injuries, outcome in terms of GOSE, and functional disability using the Barthel Index.
Tables
- Table 1:
Demographic and injury-related characteristics and outcomes of the 51 patients with brain stem lesions detected by MRI
Demographic Characteristics n (%) Sex Male 38 (75%) Female 13 (25%) Mechanism of injury Car crash 30 (59%) Motorcycle/Bike 10 (20%) Fall 6 (11%) Run over 5 (10%) Pupillary abnormality 16 (31%) Motor GCS 1 19 (37%) 2 8 (16%) 3 7 (14%) 4 10 (20%) 5 7 (14%) Hypotension/hypoxia 14 (27%) TCDB CT Classification Type I 2 (4%) Type II 37 (73%) Type III 3 (6%) Type IV 1 (2%) Type V 8 (16%) Outcome GOSE Dead 3 (6%) Vegetative state 3 (6%) Lower severe disability 15 (29%) Upper severe disability 5 (10%) Lower moderate disability 6 (12%) Upper moderate disability 5 (10%) Lower good recovery 7 (14%) Upper good recovery 6 (12%) Poor outcome 34 (66%) Barthel Index ≤95 27 (53%) Note:—TCDB indicates Traumatic Coma Data Bank.
MRI Findings n(%) Hemorrhagic lesion 32(63%) Brain stem location Mesencephalon 43(84%) Pons 2(4%) Medulla 3(6%) More than 1 3(6%) Posterior location 27(53%) Anterior location 24(47%) Bilateral 13(26%) - Table 3:
Relationship between MR findings and GOSE in 51 patients with brain stem injuries after severe head trauma
MRI Findings Good Outcome P Value OR(95% CI) S Sp PPV +LR AUC Presentn (%) Absentn (%) Nonhemorrhagic 11 (58%) 6 (19%) <.01 5.9 (1.6–22) 65 76 58 2.75 0.71 Unilateral 17 (33%) 0 <.05 – 100 38 44 1.62 0.69 Anterior 13 (54%) 4 (15%) <.05 6.8 (1.8–25) 76 68 54 2.36 0.72 Anterior + nonhemorrhagic 15 (50%) 2 (10%) <.01 9.5 (1.8–48) 88 56 50 2 0.72 Anterior + nonhemorrhagic or unilateral 15 (60%) 2 (8%) <.01 18 (3.5–93) 88 71 60 3 0.79 Note:—AUC = area under the ROC curve; +LR = positive likelihood ratio; S, sensitivity; Sp, specificity.
