Neuropathology of the Traumatic Apallic Syndrome

Peters, Glen; Rothemund, Elisabeth

doi:10.1007/978-3-642-81151-7_14

Cited by 13 publications

(2 citation statements)

References 1 publication

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“…Strich 1471 described 5 cases of human injury with the characteristic pathological findings that now define the severe end of the spectrum of DAI. Strich's findings have been confirmed by numerous other investigators [ 12,25,28,29,33,38,[41][42][43], while [47-501 championed shear as the mechanism on the basis of Holbourn's work using gelatin models of the brain [26, 271. Although this has remained the most popular view, it has never been directly confirmed.…”

Section: Discussionmentioning

confidence: 73%

Diffuse axonal injury and traumatic coma in the primate

Gennarelli¹,

Thibault²,

Adams³

et al. 1982

Annals of Neurology

1,320

640

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Traumatic coma was produced in 45 monkeys by accelerating the head without impact in one of three directions. The duration of coma, degree of neurological impairment, and amount of diffuse axonal injury (DAI) in the brain were directly related to the amount of coronal head motion used. Coma of less than 15 minutes (concussion) occurred in 11 of 13 animals subjected to sagittal head motion, in 2 of 6 animals with oblique head motion, and in 2 of 26 animals with full lateral head motion. All 15 concussioned animals had good recovery, and none had DAI. Conversely, coma lasting more than 6 hours occurred in one of the sagittal or oblique injury groups but was present in 20 of the laterally injured animals, all of which were severely disabled afterward. All laterally injured animals had a degree of DAI similar to that found in severe human head injury. Coma lasting 16 minutes to 6 hours occurred in 2 of 13 of the sagittal group, 4 of 6 in the oblique group, and 4 of 26 in the lateral group, these animals had less neurological disability and less DAI than when coma lasted longer than 6 hours. These experimental findings duplicate the spectrum of traumatic coma seen in human beings and include axonal damage identical to that seen in sever head injury in humans. Since the amount of DAI was directly proportional to the severity of injury (duration of coma and quality of outcome), we conclude that axonal damage produced by coronal head acceleration is a major cause of prolonged traumatic coma and its sequelae.

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Section: Discussionmentioning

confidence: 73%

Diffuse axonal injury and traumatic coma in the primate

Gennarelli¹,

Thibault²,

Adams³

et al. 1982

Annals of Neurology

1,320

640

View full text Add to dashboard Cite

show abstract

“…Zum zweiten wird mit dem Begriff des Palli-ums, also des Hirnmantels, die Lokalisation einer Pathologie postuliert (82), die pathogenetischen Überlegungen und neuropathologischen Befunden nicht standhält. Die Verteilung der pathologischen Läsionen, die zu demselben klinischen Bild führen, kann in Form laminarer Nekrosen auf den Kortex selbst begrenzt sein, kann aber genauso subkortikale Strukturen in Form einer diffusen Schädigung von Axonen (62) oder einer ausgedehnten Demyelinisierung betreffen oder multifokal sein (\ 1, 46,61,117). Dabei ist der gemeinsame Faktor die Schwere der hemisphärischen Schädigung oder die Trennung des zerebralen Kortex von Verbindungen zu tiefen Kernsystemen.…”

Section: Zur Geschichte Des Begriffesunclassified

Das ,,apallische Syndrom" - zu Notwendigkeit und Konsequenzen einer Begriffsklärung

Kallert¹

1994

Fortschr Neurol Psychiatr

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Starting from the increasing clinical requirement to make grave decisions (e.g. discontinuation of treatment) during hospitalisation of patients in an apallic syndrome, problems of defining the "apallic syndrome"--compared with the Anglo-American term "persistent vegetative state"--are reviewed. Besides conceptual criticism based on pathogenetic considerations and neuropathological findings the author especially demonstrates the varying inclusion criteria of the clinical syndrome concerning the apallic syndrome as well as the persistent vegetative state. Furthermore attempts to introduce more precisely defined subgroups (e.g. complete apallic syndrome) and new competing terms are shown. Referring to clinical diagnosis the low value of technical studies resulting from a great range of--sometimes controversial--findings contrasts with the high importance of identifying clinically related syndromes. Recent prognostic data that apply to judging the permanence of an apallic syndrome or persistent vegetative state are discussed. From this follows that they are of limited validity for the single patient. Finally it is attempted to work out some implications for clinical proceedings that should enable to meet a situation afflicted with diagnostic and prognostic uncertainties according to the present medical knowledge.

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Acute Direct and Indirect Lesions of the Brain Stem—CT Findings and Their Clinical Evaluation

Laun

1987

Primary and Secondary Brain Stem Lesions

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Neuropathology of the Traumatic Apallic Syndrome

Cited by 13 publications

References 1 publication

Diffuse axonal injury and traumatic coma in the primate

Diffuse axonal injury and traumatic coma in the primate

Das ,,apallische Syndrom" - zu Notwendigkeit und Konsequenzen einer Begriffsklärung

Acute Direct and Indirect Lesions of the Brain Stem—CT Findings and Their Clinical Evaluation

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