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Post-traumatic interpeduncular cistern hemorrhage as a marker for brainstem lesions
Luigi Beretta1, Nicoletta Anzalone, Antonio Dell'Acqua
1Head and Neck Department, San Raffaele Scientific Institute, Milan, Italy.
Journal of Neurotrauma
|November 27, 2009
Summary
Interpeduncular cistern blood on CT scans is a reliable early indicator for diagnosing brainstem lesions in diffuse axonal injury patients. This finding aids in identifying potential brainstem injuries in unexplained coma cases post-trauma.
Area of Science:
- Neuroscience
- Radiology
- Trauma Surgery
Background:
- Diffuse axonal injury (DAI) is a common and severe traumatic brain injury.
- Diagnosing brainstem lesions (BSL) early is crucial for patient management.
- Computed tomography (CT) is often the initial imaging modality.
Purpose of the Study:
- To evaluate the accuracy of interpeduncular cistern (IPC) blood on CT scans for diagnosing BSL in DAI patients.
- To determine the sensitivity and specificity of IPC blood as an early marker for BSL.
Main Methods:
- Retrospective review of a prospectively collected database of DAI patients.
- Inclusion criteria: coma (GCS < 9), neurological derangement not due to other causes, absence of other explanatory lesions, and MRI compatibility.
- Comparison of CT findings (IPC blood) with MRI-confirmed BSL.
Main Results:
- Patients with MRI-confirmed BSL showed a significantly higher incidence of IPC blood on CT (77.92%) compared to those without BSL (20.00%; p < 0.0001).
- The presence of IPC blood on CT had a sensitivity of 0.78 and a specificity of 0.80 for detecting BSL.
- A positive CT scan with IPC blood had a 3.90 likelihood ratio for BSL.
Conclusions:
- Finding IPC blood on early post-trauma CT scans is a valuable marker for potential brainstem lesions in patients with unexplained coma.
- This CT finding can aid in the early identification and management of DAI patients with BSL.
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