Prognostic Factors in Patients with Diffuse Axonal Injury.

Eum, Sung Wha; Lim, Dong Jun; Kim, Bong Ryong; Cho, Tai Hyung; Park, Jung Yul; Suh, Jung Keun; Lee, Ki Chan; Lee, Hoon Kap

Original Article

Journal of Korean Neurosurgical Society 1998;27(12): 1668-1674.

Sung Wha Eum, Dong Jun Lim, Bong Ryong Kim, Tai Hyung Cho, Jung Yul Park, Jung Keun Suh, Ki Chan Lee, Hoon Kap Lee

Department of Neurosurgery, Korea University Medical College, Seoul, Korea.

ABSTRACT

Diffuse axonal injury(AI) s a severe form of traumatic brain injury and it is associated with immediate coma lasting from six hours to prolonged coma. Object of this study was to review various clinical parameters which might have been related to outcome of patients with DAI and, thus, to provide some valuable guidelines in management. A series of 41 patients of DAI treated in our institution between October 1992 to September 1997 are included in this study. Clinical factors such as age, sex, Glasgow Coma Scale(CS), duration of coma, presence of hypotension at admission, hypoxemia, signs of hypothalamic injury, abnormal eyeball movement, abnormal light reflex, abnormal electrocardiography, cerebral infarct, and seizure are reviewed and analyzed in conjunction with outcome. Among all clinical factors evaluated for the statistical significances only initial GCS, hypoxemia, abnormal light reflex, signs of hypothalamic injury, abnormal motor response(decortication or decerebration) at admission revealed to have significant correlation with outcome. Factors such as age, hypotension, abnormal ECG, cerebral infarct, seizure were not statistically significant in our study. Other findings, such as causes of deaths(old age associated with either expanding hemorrhage or hemorrhage in posterior fossa) in 2 of 9 patientswith initial GCS greater than 13 and highest mortality rate for patients with combined hypoxemia and hypotension, should also be stressed. These findings suggest that when such clinical settings are evident physicians should be borne in mind that these will play unfavorable role to patients in terms of outcome and prognosis. Thus, careful and prompt attention should be given to these patients, especially treating elderly patients, even though they may have good initial GCSs.

Key Words: Diffuse axonal injury; Head trauma; Prognosis