Neuropathological Findings in Disabled Survivors of a Head Injury

Adams, J.H., Jennett, B., Murray, L.S., Teasdale, G.M., Gennarelli, T.A. and Graham, D.I. (2011) Neuropathological Findings in Disabled Survivors of a Head Injury. Journal of Neurotrauma, 28(5), pp. 701-709. (doi: 10.1089/neu.2010.1733)

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Publisher's URL: http://dx.doi.org/10.1089/neu.2010.1733

Abstract

We investigated how the occurrence and severity of the main neuropathological types of traumatic brain injury (TBI) influenced the severity of disability after a head injury. Eighty-five victims, each of whom had lived at least a month after a head injury but then died, were studied. Judged by the Glasgow Outcome Scale (GOS), before death 35 were vegetative, 30 were severely and 20 were moderately disabled. Neuropathological assessment showed that 71 (84%) victims had sustained cerebral contusions, 49 (58%) had diffuse axonal injury (DAI), 57 (67%), had ischemic brain damage (IBD), 58 (68%) had symmetrical ventricular enlargement, and in 47 (55%) intracranial pressure (ICP) had been increased. Thirty-five (41%) had undergone evacuation of an intracranial hematoma. Brainstem damage was seen in only 11 (13%). Analysis (chi(2) test for trends) of the relationship between these features and outcome showed that findings of DAI, raised ICP, thalamic damage, or ventricular enlargement (all p < 0.005), and IBD (p = 0.04) were associated with an increasingly worse outcome. Conversely, moderate or severe contusions (p = 0.001) were increasingly associated with better outcomes, and evacuation of a hematoma was associated (p = 0.001) with outcomes likely to be better than vegetative. We conclude that diffuse or multifocal neuropathological patterns of TBI from primary axonal injury or secondary ischemic damage are most likely to be associated with the most severely impaired outcomes after a head injury.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Teasdale, Professor Graham and Graham, Professor David Ian and Murray, Dr Lilian
Authors: Adams, J.H., Jennett, B., Murray, L.S., Teasdale, G.M., Gennarelli, T.A., and Graham, D.I.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Journal of Neurotrauma
ISSN:0897-7151

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