Diffuse Brain Injury and Brainstem Dysfunction

  • N. Nakamura
Part of the Advances in Neurotraumatology book series (NEUROTRAUMATOL., volume 3)


A Glasgow Neuropathologist, Adams, and the Pennsylvanian Neurosurgeons Bruce and Gennarelli introduced the terms “diffuse brain damage” and “diffuse axonal injury” on the basis of experimental data and on clinical and pathological observations (Adams et al. 1977, 1983, Bruce et al. 1978, 1981). Zimmermann, Bilaniuk and Gennarelli (1978) described the neuroradiological findings of shearing injuries of the white matter as seen on computerised tomography.


Head Injury Severe Head Injury Diffuse Axonal Injury Diffuse Brain Medial Longitudinal Fasciculus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Adams JH, Mitchell DE, Graham DI, Doyle D (1977) Diffuse brain damage of immediate impact type. Its relationship to primary brainstem damage in head injury. Brain 100: 489–502PubMedCrossRefGoogle Scholar
  2. 2.
    Adams JH, Graham DI, Murry IS, Scott G (1983) Diffuse axonal injury due to nonmissile head injury in humans: An analysis of 45 cases. Ann Neurol 12: 557–563CrossRefGoogle Scholar
  3. 3.
    Adams JH, Graham DI, Gennarelli TA (1983) Head injury in man and experimental animals: neuropathology. Acta Neurochir (Wien) [Suppl] 32: 15–30Google Scholar
  4. 4.
    Britt RH, Herrick MK, Hamilton RD (1977) Traumatic locked-in syndrome. Ann Neurol 1: 590–592PubMedCrossRefGoogle Scholar
  5. 5.
    Bruce DA, Schut L, Bruno LA, Wood JH, Sutton LN (1978) Outcome following severe head injuries in children. J Neurosurg 48: 679–688PubMedCrossRefGoogle Scholar
  6. 6.
    Bruce DA, Alavi A, Bilaniuk L, Dolinskas C, Obrist W, Uzzell B (1981) Diffuse cerebral swelling following head injuries in children: the syndrome of “malignant brain edema”. J Neurosurg 54: 170–178PubMedCrossRefGoogle Scholar
  7. 7.
    Cooper PR, Maravilla K, Kirkpatrick J, Moody SF, Skalar FH, Diehl J, Clark K (1979) Traumatically induced brainstem hemorrhage and the computed tomographic scan. Neurosurg 4: 115–124CrossRefGoogle Scholar
  8. 8.
    Crompton MR (1971) Brainstem lesions due to closed head injury. Lancet I: 669–673Google Scholar
  9. 9.
    Firsching R, Frowein RA Evoked potentials in head injuries. In this volume 10. Frowein RA, Stammler U, Firsching R, Friedmann G, Thun F Early dynamic evolution of cerebral contusions and lacerations — Clinical and radiological findings. In this volumeGoogle Scholar
  10. 11.
    Gennarelli RA (1982) Cerebral concussion and diffuse brain injuries In: Cooper PR (ed) Head injury. Baltimore, Williams and Wilkins, pp 83–97Google Scholar
  11. 12.
    Giannota SL, Weiss MH (1981) Pitfalls in the diagnosis of head injury. Clin Neurosurg 29: 188–299Google Scholar
  12. 13.
    Gurdjian ES, Brihaye J, Christensen JC, Frowein RA, Lindgren S, Luyendijk W, Norlén G, Ommaya AK, Oprescu J, de Vasconcellos Marques A, Vigouroux RP (1979) Glossary of neurotraumatology. Acta Neurochir (Wien), [Suppl] 25. Springer, Wien New YorkGoogle Scholar
  13. 14.
    Hayashi T (1969) Study of intracranial pressure caused by head impact. J Faculty of Engineering Univ Tokyo (B) 30: 59–72Google Scholar
  14. 15.
    Holbourn AHS (1943) Mechanism of head injuries. Lancet II: 438–441CrossRefGoogle Scholar
  15. 16.
    Kanda R, Nakamura N, Sekino S, Yuki K, Satoh J, Kikuchi K, Sanada S (1981) Experimental head injury in monkeys. Concussion and its tolerance level. Neurol Med-Chir 21: 645–656CrossRefGoogle Scholar
  16. 17.
    Kobayashi MS, Yokota H, Kitamura T, Imaya H, Yajima K, Nakazawa S, Yano M, Otsuka T (1984) Diffuse axonal injury. Neurotraumatology 7: 243–248 (in Japanese with English abstract)Google Scholar
  17. 18.
    Lindenberg R, Freitag E (1960) The mechanism of cerebral contusions. A pathologic-anatomic study. Arch Pathol 69: 440–469PubMedGoogle Scholar
  18. 19.
    Lobato RD, Sarabia R, Rivas JJ, Cordobes F, Castro S, Munos MJ, Cavrera A, Barcena A, Limas E (1986) Normal computerized tomography scan in severe head injury. J Neurosurg 65: 784–789PubMedCrossRefGoogle Scholar
  19. 20.
    Masuzawa H, Nakamura N, Hirakawa K, Sekino H, Matsuno M, Sano K (1976) Experimental head injury and concussion in monkey using pure linear acceleration impact. Neurol Med-Chir 16; Part 1: 77–90CrossRefGoogle Scholar
  20. 21.
    Mayer ETh (1967) Zentrale Hirnschäden nach Einwirkung stumpfer Gewalt auf den Schädel. Arch Psychiatr Nervenkr 210: 238–262PubMedCrossRefGoogle Scholar
  21. 22.
    Mitchell DE, Adams JH (1973) Primary focal impact damage to the brainstem in blunt head injuries. Does it exist? Lancet II: 215–218CrossRefGoogle Scholar
  22. 23.
    Nakamura N, Nasuzawa H, Sekino H, Kondo H, Kikuchi A, Ono K (1981) Which is the more severe impact on the head, sagittal or lateral? In: Ommaya AK et al (eds) Head and neck injury criteria. National Highway Traffic Safety Administration USA, Washington DC, pp 61–69Google Scholar
  23. 24.
    Nakamura N, Sekino H, Kanda R, Masuzawa H, Mii K, Ariga R, Kono H, Sugiura M (1984) Dynamic mechanism of concussion in experimental head injury. Neurotraumatology 7: 1–8 (in Japanese with English abstract)Google Scholar
  24. 25.
    Nakamura N (1986) Experimental head injuries due to direct impact acceleration-Head tolerance limit to impact. In: Anthony Sances jr et al. (eds) Mechanisms of head and spine trauma. Aloray Pub, New York, pp 152–235Google Scholar
  25. 26.
    Ommaya AK, Gennarelli TA (1974) Cerebral concussion and traumatic unconsciousness. Brain 97: 633–654PubMedCrossRefGoogle Scholar
  26. 27.
    Ono J, Yamaura A, Isobe K, Kotaki M, Watanabe Y, Saeki N, Nakamura T, Makino H (1983) Analysis of CT findings in severe head injuries with special reference to hemorrhagic lesions in the corpus callosum, basal ganglion and brain stem. Neurotraumatology 6: 111–226 (in Japanese with English abstract)Google Scholar
  27. 28.
    Ono K, Kikuchi A, Nakamura M, Kobayashi H, Nakamura N (1980) Human head intolerance to sagittal impact. Proc Twenty-Fourth STAPP Car Crash Conf Society of Automotive Engineers, New York, pp 101–160Google Scholar
  28. 29.
    Ono K, Kikuchi A, Kobayashi H, Nakamura N (1985) Human head tolerance to sagittal and lateral impacts. — Estimation deduced from experimental head injury using subhuman primates and human cadaver skulls. In: Head injury prevention — past and present research. Wayne State University, Detroit, pp 35–72Google Scholar
  29. 30.
    Sato O, Sugita K, Ookoshi Y, Suzuki M, Umei M (1974) Lesion of the MLF syndrome following head injury. Neurochirurgia (Stuttgart) 17: 141–145Google Scholar
  30. 31.
    Sekino H, Nakamura N, Yuki K, Satoh J, Kikuchi K, Sanada S (1981) Brain lesions detected by CT scans in cases of minor head injuries. Neurol Med-Chir 21: 677–683CrossRefGoogle Scholar
  31. 32.
    Strich SJ (1956) Diffuse degeneration of the cerebral white matter in severe dementia following head injury. J Neurol Neurosurg Psychiatry 19: 163–185PubMedCrossRefGoogle Scholar
  32. 33.
    Strich SJ (1961) Shearing of nerve fibers as a cause of brain damage due to head injury. Lancet II: 443–448CrossRefGoogle Scholar
  33. 34.
    Sweet RC, Miller JD, Liper M, Kishore PR, Becker DP (1978) Significance of bilateral abnormalities on the CT scan in patients with severe head injury. Neurosurg 3: 16–21CrossRefGoogle Scholar
  34. 35.
    Tsai FY, Teal JE, Quinn MM, Itabashi HH, Huprich JE, Ahmadi J, Segall HD (1980) CT of brainstem injury. AJNR 1: 23–29Google Scholar
  35. 36.
    Turazzi D, Bricolo A (1977) Acute pontine syndrome following head injury. Lancet II: 62–64CrossRefGoogle Scholar
  36. 37.
    Vigouroux RP, Guillermain P, Rabehanta P, Cerebral contusions — lacerations — clinical study. In this volumeGoogle Scholar
  37. 38.
    Zimmermann RA, Bilaniuk LT, Gennarelli T (1978) Computed tomography of shearing injuries of the cerebral white matter. Radiology 127: 393–396Google Scholar
  38. 39.
    Zuccarello M, Fiore DL, Trincia G, DeCaro R, Pardatscher K, Andrioli GC (1983) Traumatic primary brain stem hemorrhage. Acta Neurochir (Wien) 67: 103–113CrossRefGoogle Scholar

Copyright information

© Springer-Verlag/Wien 1991

Authors and Affiliations

  • N. Nakamura
    • 1
  1. 1.Department of NeurosurgeryTokyo Jikei University School of MedicineTokyoJapan

Personalised recommendations