2011 Volume 34 Issue 1 Pages 46-53
Object. Previous studies have shown a relationship between a patient's stage of diffuse axonal injury (DAI) and outcome. However, few studies have assessed whether a specific lesion or type of corpus callosum injury (CCI) influences outcome in patients with DAI. We investigated the effect of various DAI and CCI lesions on outcome in patients with traumatic brain injury (TBI).
Methods. We retrospectively reviewed 89 consecutive patients with DAI who were seen between May 2004 and May 2010. Outcome was evaluated with the Extended Glasgow Outcome Scale (EGOS) 1 year after TBI. Cases with single-DAI had only one of the 3 lesions (lobar, corpus callosum, or brainstem). Dual-DAI cases had 2 of these lesions, and triple-DAI cases had all these lesions. Furthermore, we defined single-CCI, dual-CCI, and triple-CCI using 3 lesions (genu, body, splenium) in the same way among patients with single (corpus callosum)-DAI. Univariate and multivariate logistic regression analyses were performed to evaluate the relationships between these lesions and outcome in patients with DAI.
Results. Fifty seven patients had single-DAI lesions: 40 in the lobar, 12 in the CC, and 5 in the brainstem. Twenty four had dual-DAI lesions, and 8 had triple-DAI lesions. Of the 12 CCI, 9 had single-CCI, and 3 had dual-CCI. Only lesions in genu were related to disability among these lesions. We dichotomized patients into those with and without genu lesions regardless of other lesions. Multinominal logistic regression analysis showed that a genu lesion (OR, 27; 95% CI, 3.4 – 32; p=0.0032) and a pupillary abnormality (OR, 6.2; 95% CI, 1.2 – 21; p=0.0032) were associated with disability (EGOS ≤ 6) in DAI patients.
Conclusions. Regardless of the number of lesions, the existence of a genu lesion suggested disability 1 year after TBI in patients with DAI.
