22
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: not found

      Imaging for the Diagnosis and Management of Traumatic Brain Injury

      research-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Summary

          To understand the role of imaging in traumatic brain injury (TBI), it is important to appreciate that TBI encompasses a heterogeneous group of intracranial injuries and includes both insults at the time of impact and a deleterious secondary cascade of insults that require optimal medical and surgical management. Initial imaging identifies the acute primary insult that is essential to diagnosing TBI, but serial imaging surveillance is also critical to identifying secondary injuries such as cerebral herniation and swelling that guide neurocritical management. Computed tomography (CT) is the mainstay of TBI imaging in the acute setting, but magnetic resonance tomography (MRI) has better diagnostic sensitivity for nonhemorrhagic contusions and shear-strain injuries. Both CT and MRI can be used to prognosticate clinical outcome, and there is particular interest in advanced applications of both techniques that may greatly improve the sensitivity of conventional CT and MRI for both the diagnosis and prognosis of TBI.

          Electronic supplementary material

          The online version of this article (doi:10.1007/s13311-010-0003-3) contains supplementary material, which is available to authorized users.

          Related collections

          Most cited references51

          • Record: found
          • Abstract: found
          • Article: not found

          The ABCs of measuring intracerebral hemorrhage volumes.

          Hemorrhage volume is a powerful predictor of 30-day mortality after spontaneous intracerebral hemorrhage (ICH). We compared a bedside method of measuring CT ICH volume with measurements made by computer-assisted planimetric image analysis. The formula ABC/2 was used, where A is the greatest hemorrhage diameter by CT, B is the diameter 90 degrees to A, and C is the approximate number of CT slices with hemorrhage multiplied by the slice thickness. The ICH volumes for 118 patients were evaluated in a mean of 38 seconds and correlated with planimetric measurements (R2 = 9.6). Interrater and intrarater reliability were excellent, with an intraclass correlation of .99 for both. We conclude that ICH volume can be accurately estimated in less than 1 minute with the simple formula ABC/2.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Surgical management of acute subdural hematomas.

            An acute subdural hematoma (SDH) with a thickness greater than 10 mm or a midline shift greater than 5 mm on computed tomographic (CT) scan should be surgically evacuated, regardless of the patient's Glasgow Coma Scale (GCS) score. All patients with acute SDH in coma (GCS score less than 9) should undergo intracranial pressure (ICP) monitoring. A comatose patient (GCS score less than 9) with an SDH less than 10-mm thick and a midline shift less than 5 mm should undergo surgical evacuation of the lesion if the GCS score decreased between the time of injury and hospital admission by 2 or more points on the GCS and/or the patient presents with asymmetric or fixed and dilated pupils and/or the ICP exceeds 20 mm Hg. In patients with acute SDH and indications for surgery, surgical evacuation should be performed as soon as possible. If surgical evacuation of an acute SDH in a comatose patient (GCS < 9) is indicated, it should be performed using a craniotomy with or without bone flap removal and duraplasty.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              The role of secondary brain injury in determining outcome from severe head injury.

              As triage and resuscitation protocols evolve, it is critical to determine the major extracranial variables influencing outcome in the setting of severe head injury. We prospectively studied the outcome from severe head injury (GCS score < or = 8) in 717 cases in the Traumatic Coma Data Bank. We investigated the impact on outcome of hypotension (SBP < 90 mm Hg) and hypoxia (Pao2 < or = 60 mm Hg or apnea or cyanosis in the field) as secondary brain insults, occurring from injury through resuscitation. Hypoxia and hypotension were independently associated with significant increases in morbidity and mortality from severe head injury. Hypotension was profoundly detrimental, occurring in 34.6% of these patients and associated with a 150% increase in mortality. The increased morbidity and mortality related to severe trauma to an extracranial organ system appeared primarily attributable to associated hypotension. Improvements in trauma care delivery over the past decade have not markedly altered the adverse influence of hypotension. Hypoxia and hypotension are common and detrimental secondary brain insults. Hypotension, particularly, is a major determinant of outcome from severe head injury. Resuscitation protocols for brain injured patients should assiduously avoid hypovolemic shock on an absolute basis.
                Bookmark

                Author and article information

                Contributors
                jane.kim@radiology.ucsf.edu
                Journal
                Neurotherapeutics
                Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics
                Springer-Verlag (New York )
                1933-7213
                1878-7479
                8 January 2011
                8 January 2011
                January 2011
                : 8
                : 1
                : 39-53
                Affiliations
                Department of Radiology, San Francisco General Hospital, University of California, 1001 Potrero Avenue, Box 1325, San Francisco, California 94143 USA
                Article
                3
                10.1007/s13311-010-0003-3
                3026928
                21274684
                1095d720-dd26-4d80-81f4-841806ac2238
                © The Author(s) 2011
                History
                Categories
                Article
                Custom metadata
                © The American Society for Experimental NeuroTherapeutics, Inc. 2011

                Neurology
                tbi,contusion,epidural,traumatic shear injury,hemorrhage,subdural
                Neurology
                tbi, contusion, epidural, traumatic shear injury, hemorrhage, subdural

                Comments

                Comment on this article