Does Diffuse Axonal Injury MRI Grade Really Correlate with Functional Outcome?

Lohani, Subash; Bhandari, Shreeram; Ranabhat, Kajan; Agrawal, Prity

doi:10.1016/j.wneu.2019.12.017

Cited by 10 publications

(15 citation statements)

References 22 publications

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“…Although coma is usually associated with a bad outcome, this is way different for DAI. Analyses of patients with evidence of DAI report a low mortality rate of 2–25% [ 172 , 173 , 174 , 175 , 176 ], as well as a good functional outcome [ 172 , 175 , 177 , 178 , 179 , 180 ] and quality of life [ 173 , 177 ]. The presence of typical DAI lesions and the anatomical classification of imaging studies do not predict survival or functional status, let alone quality of life [ 173 , 175 ].…”

Section: Factors Excluded As Contraindications/additional Contraindications Onlymentioning

confidence: 99%

Contraindications to the Initiation of Veno-Venous ECMO for Severe Acute Respiratory Failure in Adults: A Systematic Review and Practical Approach Based on the Current Literature

Harnisch

Moerer

2021

Membranes

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(1) Background: Extracorporeal membrane oxygenation (ECMO) is increasingly used for acute respiratory failure with few absolute but many relative contraindications. The provider in charge often has a difficult time weighing indications and contraindications to anticipate if the patient will benefit from this treatment, a decision that often decides life and death for the patient. To assist in this process in coming to a good evidence-based decision, we reviewed the available literature. (2) Methods: We performed a systematic review through a literature search of the MEDLINE database of former and current absolute and relative contraindications to the initiation of ECMO treatment. (3) Results: The following relative and absolute contraindications were identified in the literature: absolute—refusal of the use of extracorporeal techniques by the patient, advanced stage of cancer, fatal intracerebral hemorrhage/cerebral herniation/intractable intracranial hypertension, irreversible destruction of the lung parenchyma without the possibility of transplantation, and contraindications to lung transplantation; relative—advanced age, immunosuppressed patients/pharmacological immunosuppression, injurious ventilator settings > 7 days, right-heart failure, hematologic malignancies, especially bone marrow transplantation and graft-versus-host disease, SAPS II score ≥ 60 points, SOFA score > 12 points, PRESERVE score ≥ 5 points, RESP score ≤ −2 points, PRESET score ≥ 6 points, and “do not attempt resuscitation” order (DN(A)R status). (4) Conclusions: We provide a simple-to-follow algorithm that incorporates absolute and relative contraindications to the initiation of ECMO treatment. This algorithm attempts to weigh pros and cons regarding the benefit for an individual patient and hopefully assists caregivers to make better, informed decisions.

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Section: Factors Excluded As Contraindications/additional Contraindications Onlymentioning

confidence: 99%

Contraindications to the Initiation of Veno-Venous ECMO for Severe Acute Respiratory Failure in Adults: A Systematic Review and Practical Approach Based on the Current Literature

Harnisch

Moerer

2021

Membranes

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“…e prognosis of patients presenting with unilateral or bilateral fixed and dilated pupils in the setting of TBI without a mass lesion is generally devastating [24]. Decision-making in TBI should always be in adherence to internationally agreed management protocols relying on clinical history, neurological examination, neuroradiological investigations, and continuous multimodality monitoring [14,16]. While the goal should be to maintain a good ICP and CBF, prognostic factors are to be kept into account [15,24].…”

Section: Management and Prognosismentioning

confidence: 99%

“…To elucidate the mechanism of injury underlying 3cnP, we present five exemplificative cases of isolated 3cnP in patients suffering severe closed TBI with documented Grade III DAI [16]. Together with a literature review, these cases will help to outline four possible mechanisms of injury in mild to severe TBI and better explain the anatomical basis of 3cnP.…”

Section: Introductionmentioning

confidence: 99%

Clinical Significance of Isolated Third Cranial Nerve Palsy in Traumatic Brain Injury: A Detailed Description of Four Different Mechanisms of Injury through the Analysis of Our Case Series and Review of the Literature

Uberti

Hasan

Holmes

et al. 2021

Emergency Medicine International

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Third cranial nerve palsy (3cnP) following traumatic brain injury (TBI) is a worrying neurological sign and is often associated with an expanding mass lesion, such as extradural or acute subdural haematomas. Isolated 3cnP can be found in the absence of posttraumatic space-occupying mass lesion, yet it is often considered as a devastating prognostic factor in the context of diffuse axonal injury (DAI). Through the analysis of five exemplificative cases and a thorough review of the literature, we identified four possible mechanisms leading to 3cnP: (1) a partial rootlet avulsion at the site of exit from the midbrain, representing a direct shearing injury to the nerve; (2) a direct traction injury due to the nerve stretching against the posterior petroclinoid ligament at the base of the oculomotor triangle secondary to the downward displacement of the brainstem at the time of impact; (3) a direct vascular compression as a result of internal carotid artery (ICA) dissection or pseudoaneurysm; (4) an indirect injury caused by impaired blood supply to the third nerve in addition to the detrimental biochemical effects of the underlying brain injury itself. Understanding the exact mechanism underlying the onset of 3cnP is key to provide an informed clinical decision-making to the patients and ensure their best chances of recovery. Our experience corroborates data from the literature showing that, even in Grade III DAI, prompt recognition of isolated 3cnP can guide adequate treatment. Nonetheless, even when an overall good neurological outcome is achieved, recovery of isolated 3cnP is dismal, and only rarely the visual deficit completely resolves.

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“…13 Most of the patients fall into class II and class III of the histopathological classification of DAI, corresponding to poor outcome. 1,17…”

Section: Epidemiologymentioning

confidence: 99%

Contemporary insight into diffuse axonal injury

Angelova¹,

Kehayov²,

Davarski³

et al. 2021

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Diffuse axonal injury (DAI) is present in approximately 50% of the cases with severe traumatic brain injury. It is one of the leading causes of morbidity and mortality among children and young individuals worldwide. Generally, DAI occurs as a result of high-velocity accidents. Typically, it presents with loss of consciousness for at least 6 hours and neurological deficit dependent on the brain area that is affected by the injury. The final diagnosis is confirmed by neuroimaging studies such as computed tomography and magnetic resonance imaging. According to the injured brain site, DAI is classified into three grades: Grade I–DAI with axonal lesions in the cerebral hemispheres; Grade II–DAI with focal axonal lesions in the corpus callosum; Grade III–DAI with focal or multiple axonal lesions in the brainstem. Each of the three grades is associated with different outcome.Due to the high disability and mortality rate, DAI represents an important medical, personal and social problem. The aim of the current review is to address the unsolved issues connected with the pathogenesis, diagnostics, treatment and outcome of the diffuse axonal injury.

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Does Diffuse Axonal Injury MRI Grade Really Correlate with Functional Outcome?

Cited by 10 publications

References 22 publications

Contraindications to the Initiation of Veno-Venous ECMO for Severe Acute Respiratory Failure in Adults: A Systematic Review and Practical Approach Based on the Current Literature

Contraindications to the Initiation of Veno-Venous ECMO for Severe Acute Respiratory Failure in Adults: A Systematic Review and Practical Approach Based on the Current Literature

Clinical Significance of Isolated Third Cranial Nerve Palsy in Traumatic Brain Injury: A Detailed Description of Four Different Mechanisms of Injury through the Analysis of Our Case Series and Review of the Literature

Contemporary insight into diffuse axonal injury

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