Objetive. Brain nuclear magnetic resonance (NMR) is a diagnostic test for the assessment and diagnosis of primary lesions in severe head trauma (HT). We analyze the information provided by NMR as compared to that of computerized tomography (CT) to describe lesions consistent with diffuse axonal injury (DAI), and the relationship between these lesions and the clinical severity of patients admitted with HT. Patients and methods. We have studied 64 patients admitted to our ICU with the diagnosis of HT from January 1992 to May 1994. NMR was performed in 12. We obtained information gathered from NMR that could be different from that obtained from the CT (lesion in the corpus callosum [CC], white matter [WM], and brainstem [BS]). In each case clinical outcome (discharge or exitus, Glasgow outcome score [GOS]), length of ICU stay, level of consciousness by the Glasgow coma scale [GCS], and evoked auditive potentials and electroencephalogram (EEG) were assessed. Results. In 12 patients with NMR, CC was affected in 7, WM in 6, BS in 5. These findings were consistent with the diagnosis of diffuse axonal injury. In 2 cases, CT and NMR findings were comparable. Mortality rate in the NMR group 17% was, lower than that recorded in the whole group (25%), but the difference did not reach statistical significance. ICU length of stay was greater for the NMR group than for the whole group (38.6 ± 12.1 days versus 15.9 ± 11.3 days, p < 0.001). Neuronal depression as assessed by the EEG was predominantly observed in the NMR group, and abnormal evoked potentials where detected in 3 of 6 cases. At discharge, GCS was 9.7 ± 2.7 and 11.8 ± 3.2 in patients with and without NMR, respectively (p = 0.008). There were no statiscally significant differences in GOS, although patients with DAI showed a greater severity. Conclusion. NMR has a higher sensitivity for the diagnosis of post-traumatic demielinyzing processes, such as that associated with DAI. NMR can be useful in patients with severe head truma.
|Publication status||Published - 28 Feb 1996|
- Computerized tomography
- Diffuse axonal injury
- Head trauma
- Nuclear magnetic resonance