Clinical Evaluation and Neuroimaging Technologies

, Valery Kornienko¹, Alexander Potapov² and Igor Pronin³

(1)

Department of Neuroradiology, Burdenko Neurosurgery Intitute, Moscow, Russia

(2)

Department of Neurotrauma, Burdenko Neurosurgery Insitute, Moscow, Russia

(3)

Department of Neuroradiology, Burdenko Neurosurgery Institute, Moscow, Russia

2.1 Clinical Material

2.2 Methods of Study

2.2.1 Computed Tomography

2.2.2 Magnetic Resonance Tomography

2.3 Statistical Analysis

References

Abstract

Chapter 2 presents clinical characteristics of the examined patients and neuroimaging methods. There were studied 208 patients in the acute, subacute, and delayed periods of brain trauma by generally accepted clinical and neuroimaging methods such as computed tomography and magnetic resonance imaging, also advanced MRI sequences and perfusion computed tomography. The majority of patients were in coma. Clinical and morphological diagnosis was based on the whole complex of data about mechanisms of injury, neurological symptoms, CT and MRI findings, and dynamics of the clinical course. Chapter 2 includes CT perfusion and diffusion-tensor MRI protocols, which were used in these investigations.

2.1 Clinical Material

From 2003 to 2012, 4,235 patients with neurotrauma were admitted to Burdenko Neurosurgery Institute; 1,298 (31 %) patients were hospitalized in the acute period of trauma, while the remaining 2,937 (69 %) in subacute and chronic periods. Most patients (3,194; 75.4 %) had craniocerebral trauma.

The main indication for admission was severe neurotrauma which required high-technology methods of diagnosis, surgical interventions, neurological monitoring, and intensive care. Therefore, the overwhelming majority of patients (70 %) underwent neurosurgical interventions and the remaining patients (30 %) received conservative treatment.

This analysis included 208 patients (or 16 % of TBI patients) admitted to the institute in the acute period of trauma. They were examined in the acute, subacute, and delayed periods of brain trauma by generally accepted clinical and neuroimaging methods: CT, MRI (T1, T2, T2-FLAIR, gradient echo T2* imaging), also by advanced MRI sequences (DWI, DTI, 3D gradient echo – SWAN), as well as perfusion computed tomography (CT perfusion).

Patients’ age varied from 6 to 72 years (mean age 28). Distributions of patients by age, mechanism, severity of injury, and outcome are listed in Tables 2.1, 2.2, and 2.3 and on Figs. 2.1, 2.2, and 2.3.

Table 2.1

Characteristics of the examined groups of patients (n = 208)

	Mean	Median	Minimum	Maximum	10th percentile	90th percentile	Standard deviation	Standard error
Age	30.65	28	6	72	17	49	13.12	0.91
GCS	8.04	7	3	15	4	13	3.396	0.24
GOS	3.51	3	1	5	2	5	1.077	0.07
Coma^a duration, days	10.1	9	0	37	3	17	5.92	0.58

^aEvaluated in comatose patients

Table 2.2

Distribution of patients based on the mechanism of damage

	1	2	3	4	5	6
Mechanism	Falling from height	Assault	Motor vehicle	Motorcycle	Gunshot	Unknown	Total
n	25	35	118	18	5	7	208
Percentage	12	16.8	56.7	8.7	2.4	3.4	100

Table 2.3

Distribution of patients by Glasgow Outcome Scale

GOS	1	2	3	4	5	Total
n	12	16	77	61	42	208
Percentage	5.8	7.7	37	29.3	20.2	100

1, death; 2, vegetative state; 3, severe disability; 4, moderate disability; 5, good recovery

Fig. 2.1

Distribution of patients (n = 208) by age

Fig. 2.2

Distribution of patients by Glasgow Coma Scale (GCS), n = 208

Fig. 2.3

Distribution of patients by coma duration (n = 106, number of patients with known duration). Red curve shows expected normal (Gaussian) distribution

The main group (96.2 %) was presented by patients aged under 59, with half of them (54.8 %) being young people under 29 years old (Fig. 2.1); 62 of them were female (29.8 %) and 146 (70.2 %) male.

The main causes of head injury were traffic accidents (motor vehicle accidents: car or motorcycle) (65.4 %), assaults (16.8 %), and falls from one’s own or great heights (12 %). The rest of the trauma mechanisms made up 5.8 % (Table 2.2).

Patients’ severity state at admission was evaluated by Glasgow Coma Scale (GCS) and varied from score 3 to 15 (average score, 7) (Teasdale and Jennett 1974). The majority of patients were in coma – GCS score ≤ 8 (n = 139; 66.8 %) (Fig. 2.2), with its duration widely varied (Fig. 2.3).

Evaluation of patients by Glasgow Outcome Scale (Jennett and Bond 1975) showed prevalence of severe disability, n = 77; 37 % (Table 2.3). However, there was no significant predominance of unfavorable outcome (n = 105; 50.5 %) over favorable one (n = 103; 49.5 %).

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