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Reliability of Magnetic Resonance Tractography in Predicting Early Clinical Improvements in Patients with Diffuse Axonal Injury Grade III

  • Sunil MunakomiEmail author
  • Deepak Poudel
  • Sangam Shrestha
Part of the Advances in Experimental Medicine and Biology book series


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.


Axonal injury Brain Corticospinal tracts Dysautonomia Magnetic resonance Tractography 


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.


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Copyright information

©  Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sunil Munakomi
    • 1
    Email author
  • Deepak Poudel
    • 2
  • Sangam Shrestha
    • 3
  1. 1.Department of NeurosurgeryNobel Medical College and Teaching HospitalBiratnagarNepal
  2. 2.Department of General AnesthesiaNobel Medical College and Teaching HospitalBiratnagarNepal
  3. 3.Department of PediatricsKoshi Zonal HospitalBiratnagarNepal

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