Relationship of depth of brain lesions to consciousness and outcome after closed head injury

Abstract

Magnetic resonance (MR) imaging was performed in 94 patients who sustained closed head injury of varying severity. Results of MR studies obtained after the intensive care phase of treatment disclosed that intracranial lesions were present in about 88% of the patients. Consistent with the centripetal model of progressive brain injury proposed in 1974 by Ommaya and Gennarelli, the depth of brain lesion was positively related to the degree and duration of impaired consciousness. Further analysis indicated that the relationship between depth of brain lesion and impaired consciousness could not be attributed to secondary effects of raised intracranial pressure or to the size of intracranial lesion(s).

A neuropsychiatric perspective on traumatic brain injury

“…Although little is written about this gradient in experimental animal models, clinical evidence in humans suggests that it is an important phenomenon. Aside from the neurobehavioral and neurocognitive correlates to be discussed here, the evidence from the neuroimaging literature strongly supports the existence of such a gradient, with frontal and anterior temporal lesions being significantly more frequent than lesions more posterior in the cerebral hemispheres [12][13][14]. Given the anatomy of the human brain and the membranes that invest it, perhaps this distribution is not surprising.…”

“…If a patient with TBI requires a neuroimaging study because of injury severity, examination findings, progression or persistence of symptoms, or other cause, MRI is significantly more sensitive than computed tomography (CT) in demonstrating traumatic lesions [12][13][14]. In cases where an acute surgical lesion is suspected, the speed and ease of use of CT and its adequate sensitivity for such lesions make it the primary imaging modality.…”

Severe Traumatic Head Injury: Prognostic Value of Brain Stem Injuries Detected at MRI

“…9 Concerning prognosis, the brain stem is one of the most commonly studied anatomic structures. 10 Most of the series published in the literature [11][12][13][14][15][16] report that lesions in the brain stem are associated with a worse global prognosis and less probability of recovering from a vegetative state. Those reports support the Ommaya-Gennarelli model, in which the depth of brain injury correlates with TBI morbidity and mortality.…”

Motor vehicle collision factors influence severity and type of TBI

“…These data are important for two reasons. First, these findings have been reported to be rare [25] and, secondly, deep brain lesions have been correlated with poor patient outcome [26]. Of these 12 collisions, six involved lateral impact and four involved striking a fixed object and, in this investigation, these collision types were associated with severe brain injury.…”