Abstract
Diffuse axonal injury (DAI) grade III forms a distinct subset of traumatic brain injury wherein it is difficult to predict the outcome and the time taken for early recovery in terms of sustained eye opening and standing with minimal assistance. This study seeks to determine differences in the fractional anisotropy (FI) and diffusion-weighted image (DWI) values obtained from the seeds placed at an appropriate region of interest (ROI) within the magnetic resonance (MR) tractography of the brainstem of brain-injured patients. We found that differences in the DWI values along the corticospinal tract were associated with the days required for early recovery. Moreover, dysautonomia was an independent variable governing a delayed recovery in these patients. The lesions posterior to the corticospinal tract in the brainstem conferred increased odds for the subsequent development of dysautonomia. We conclude that MR tractography, in addition to depicting the anatomical integrity of the concerned tracts, has the potential of becoming a surrogate clinical imaging marker for effectively predicting days for early recovery among patients with DAI grade III.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Abu Hamdeh S, Marklund N, Lannsjö M, Howells T, Raininko R, Wikström J, Enblad P (2017) Extended anatomical grading in diffuse axonal injury using MRI: hemorrhagic lesions in the substantia nigra and mesencephalic tegmentum indicate poor long-term outcome. J Neurotrauma 34(2):341–352
Adams H, Mitchell DE, Graham DI, Doyle D (1977) Diffuse brain damage of immediate impact type. Its relationship to “primary brain stem damage” in head injury. Brain 100:489–502
Adams JH, Doyle D, Ford I, Gennarelli TA, Graham DI, McLellan DR (1989) Diffuse axonal injury in head injury: definition, diagnosis and grading. Histopathology 15:49–59
Alberico AM, Ward JD, Choi SC, Marmarou A, Young HF (1987) Outcome after severe head injury: relationship to mass lesions, diffuse injury, and ICP course in pediatric and adult patients. J Neurosurg 67:648–656
Ashwal S, Babikian T, Gardner-Nichols J, Freier MC, Tong KA, Holshouser BA (2006) Susceptibility-weighted imaging and proton magnetic resonance spectroscopy in assessment of outcome after pediatric traumatic brain injury. Arch Phys Med Rehabil 87(12 Suppl 2):S50–S58
Baguley IJ, Nicholls JL, Felmingham KL, Crooks J, Gurka JA, Wade LD (1999) Dysautonomia after traumatic brain injury: a forgotten syndrome? J Neurol Neurosurg Psychiatry 67(1):39–43
Brezova V, Moen KG, Skandsen T, Vik A, Brewer JB, Salvesen O, Haberg AK (2014) Prospective longitudinal MRI study of brain volumes and diffusion changes during the first year after moderate to severe traumatic brain injury. Neuroimage Clin 5:128–140
Calvi MR, Beretta L, Dell’Acqua A, Anzalone N, Licini G, Gemma M (2011) Early prognosis after severe traumatic brain injury with minor or absent computed tomography scan lesions. J Trauma 70(2):447–451
Chelly H, Chaari A, Daoud E, Dammak H, Medhioub F, Mnif J et al (2011) Diffuse axonal injury in patients with head injuries: an epidemiologic and prognosis study of 124 cases. J Trauma 71(4):838–846
Dinkel J, Drier A, Khalilzadeh O, Perlbarg V, Czernecki V, Gupta R, Gomas F, Sanchez P, Dormont D, Galanaud D, Stevens RD, Puybasset L, for NICER (Neuro Imaging for Coma Emergence and Recovery) Consortium (2014) Long-term white matter changes after severe traumatic brain injury: a 5-year prospective cohort. Am J Neuroradiol 35:23–29
Eum SW, Lim DJ, Kim BR, Cho TH, Park JY, Suh JK et al (1998) Prognostic factors in patients with diffuse axonal injury. J Korean Neurosurg Soc 27:1668–1674
Fabbri A, Servadei F, Marchesini G, Stein SC, Vandelli A (2008) Early predictors of unfavorable outcome in subjects with moderate head injury in the emergency department. J Neurol Neurosurg Psychiatry 79(5):567–573
Firsching R, Woischneck D, Klein S, Ludwig K, Dohring W (2002) Brain stem lesions after head injury. Neurol Res 24(2):145–146
Gennarelli TA (1987) Cerebral concussion and diffuse brain injuries. In: Cooper PR (ed) Head injury, 2nd edn. Williams & Wilkins, Baltimore, pp 108–124
Gennarelli T, Thibault L, Adams J, Graham D, Thompson C, Marcincin R (1982) Diffuse axonal injury and traumatic coma in the primate. Ann Neurol 12:564–574
Hendricks HT, Heeren AH, Vos PE (2010) Dysautonomia after severe traumatic brain injury. Eur J Neurol 17(9):1172–1177
Inglese M, Makani S, Johnson G, Cohen BA, Silver JA, Gonen O, Grossman RI (2005) Diffuse axonal injury in mild traumatic brain injury: a diffusion tensor imaging study. J Neurosurg 103:298–303
Kim CH, Lee HK, Koh YC, Hwang DY (1997) Clinical analysis of diffuse axonal injury (DAI) diagnosed with magnetic resonance image (MRI). J Korean Neurosurg Soc 26:241–248
Kim HJ, Park IS, Kim JH, Kim KJ, Hwang SH, Kim ES et al (2001) Clinical analysis of the prognosis of the patients with cerebral diffuse axonal injuries, based on gradient-echo MR imaging. J Korean Neurosurg Soc 30:168–172
Lee HJ, Sun HW, Lee SJ, Choi NJ, Jung YJ, Hong SK (2018) Clinical outcomes of diffuse axonal injury according to radiological grade. J Trauma Inj 31(2):51–57
Ma J, Zhang K, Wang Z, Chen G (2016) Progress of research on diffuse axonal injury after traumatic brain injury. Neural Plast 2016:9746313
Mac Donald CL, Dikranian K, Song SK, Bayly PV, Holtzman DM, Brody DL (2007) Detection of traumatic axonal injury with diffusion tensor imaging in a mouse model of traumatic brain injury. Exp Neurol 205:116–131
Messori A, Polonara G, Mabiglia C, Salvolini U (2003) Is haemosiderin visible indefinitely on gradient-echo MRI following traumatic intracerebral haemorrhage? Neuroradiology 45:881–886
Moen KG, Skandsen T, Folvik M, Brezova V, Kvistad KA, Rydland J, Manley GT, Vik A (2012) A longitudinal MRI study of traumatic axonal injury in patients with moderate and severe traumatic brain injury. J Neurol Neurosurg Psychiatry 83(12):1193–1200
Oh KS, Ha SI, Suh BS, Lee HS, Lee JS (2001) The correlation of MRI findings to outcome in diffuse axonal injury patients. J Korean Neurosurg Soc 30(Suppl I):S20–S24
Park SW, Park K, Kim YB, Min BK, Hwang SN, Suk JS et al (1991) Prognostic factors in diffuse axonal injuries of brain. J Korean Neurosurg Soc 20:983–990
Park SJ, Hur JW, Kwon KY, Rhee JJ, Lee JW, Lee HK (2009) Time to recover consciousness in patients with diffuse axonal injury: assessment with reference to magnetic resonance grading. J Korean Neurosurg Soc 46(3):205–209
Sidaros A, Engberg AW, Sidaros K, Liptrot MG, Herning M, Petersen P, Paulson OB, Jernigan TL, Rostrup E (2008) Diffusion tensor imaging during recovery from severe traumatic brain injury and relation to clinical outcome: a longitudinal study. Brain 131:559–572
Skandsen T, Kvistad KA, Solheim O, Strand IH, Folvik M, Vik A (2010) 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. J Neurosurg 113(3):556–563
Strich SJ (1956) Diffuse degeneration of the cerebral white matter in severe dementia following head injury. J Neurol Neurosurg Psychiatry 19:163–185
van Eijck MM, Schoonman GG, van der Naalt J, de Vries J, Roks G (2018a) Diffuse axonal injury after traumatic brain injury is a prognostic factor for functional outcome: a systematic review and meta-analysis. Brain Inj 32(4):395–402
van Eijck M, van der Naalt J, de Jongh M, Schoonman G, Oldenbeuving A, Peluso J, de Vries J, Roks G (2018b) Patients with diffuse axonal injury can recover to a favorable long-term functional and quality of life outcome. J Neurotrauma 35(20):2357–2364
Vieira RC, Paiva WS, de Oliveira DV, Teixeira MJ, de Andrade AF, de Sousa RM (2016) Diffuse axonal injury: epidemiology, outcome and associated risk factors. Front Neurol 7:178
Zimmerman RA, Bilaniuk LT, Hackney DB, Goldberg HI, Grossman RI (1986) Head injury: early results of comparing CT and high-field MR. Am J Roentgenol 147:1215–1222
Conflicts of Interest
The authors declare no conflicts of interest in relation to this article.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of the Nobel Medical College and Teaching Hospital in Biratnagar, Nepal (IRC-NMCTH-169/2018).
Informed Consent
Written informed consent was obtained from the guardians, relatives, or next of kin concerning all individual participants included in the study.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Munakomi, S., Poudel, D., Shrestha, S. (2019). Reliability of Magnetic Resonance Tractography in Predicting Early Clinical Improvements in Patients with Diffuse Axonal Injury Grade III. In: Pokorski, M. (eds) Trends in Biomedical Research. Advances in Experimental Medicine and Biology(), vol 1251. Springer, Cham. https://doi.org/10.1007/5584_2019_445
Download citation
DOI: https://doi.org/10.1007/5584_2019_445
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-41218-0
Online ISBN: 978-3-030-41219-7
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)