Related Experiment Video
Updated: Feb 5, 2026
Induction of Diffuse Axonal Brain Injury in Rats Based on Rotational Acceleration
Published on: May 9, 2020
Intracranial pressure elevations in diffuse axonal injury: association with nonhemorrhagic MR lesions in central
Sami Abu Hamdeh1, Niklas Marklund1, Anders Lewén1
11Department of Neuroscience/Neurosurgery, Uppsala University; and.
Objective:
Increased intracranial pressure (ICP) in patients with severe traumatic brain injury (TBI) with diffuse axonal injury (DAI) is not well defined. This study investigated the occurrence of increased ICP and whether clinical factors and lesion localization on MRI were associated with increased ICP in patients with DAI.
Methods:
Fifty-two patients with severe TBI (median age 24 years, range 9-61 years), who had undergone ICP monitoring and had DAI on MRI, as determined using T2*-weighted gradient echo, susceptibility-weighted imaging, and diffusion-weighted imaging (DWI) sequences, were enrolled. The proportion of good monitoring time (GMT) with ICP > 20 mm Hg during the first 120 hours postinjury was calculated and associations with clinical and MRI-related factors were evaluated using linear regression.
Results:
All patients had episodes of ICP > 20 mm Hg. The mean proportion of GMT with ICP > 20 mm Hg was 5%, and 27% of the patients (14/52) spent more than 5% of GMT with ICP > 20 mm Hg. The Glasgow Coma Scale motor score at admission (p = 0.04) and lesions on DWI sequences in the substantia nigra and mesencephalic tegmentum (SN-T, p = 0.001) were associated with the proportion of GMT with ICP > 20 mm Hg. In multivariable linear regression, lesions on DWI sequences in SN-T (8% of GMT with ICP > 20 mm Hg, 95% CI 3%-13%, p = 0.004) and young age (-0.2% of GMT with ICP > 20 mm Hg, 95% CI -0.07% to -0.3%, p = 0.002) were associated with increased ICP.
Conclusions:
Increased ICP occurs in approximately one-third of patients with severe TBI who have DAI. Age and lesions on DWI sequences in the central mesencephalon (i.e., SN-T) are associated with elevated ICP. These findings suggest that MR lesion localization may aid prediction of increased ICP in patients with DAI.
Insights
Increased intracranial pressure (ICP) is common in severe traumatic brain injury (TBI) with diffuse axonal injury (DAI). Lesions in the central mesencephalon on MRI and younger age are linked to elevated ICP.
Area of Science:
- Neuroscience
- Radiology
- Trauma Surgery
Background:
- Severe traumatic brain injury (TBI) can lead to diffuse axonal injury (DAI).
- Increased intracranial pressure (ICP) is a critical complication in TBI patients, but its occurrence in DAI is not well-defined.
- Accurate ICP monitoring and prediction are vital for managing severe TBI.
Purpose of the Study:
- To investigate the incidence of increased ICP in patients with severe TBI and DAI.
- To determine if clinical factors and MRI-detected lesion localization are associated with increased ICP in DAI patients.
Main Methods:
- Fifty-two severe TBI patients with DAI on MRI underwent ICP monitoring.
- Diffusion-weighted imaging (DWI) sequences were used to identify DAI and specific lesion locations.
- Linear regression analysis evaluated associations between ICP levels and clinical/MRI factors.
Main Results:
- All patients experienced episodes of ICP > 20 mm Hg.
- Approximately 27% of patients had ICP > 20 mm Hg for more than 5% of monitoring time.
- Lesions in the substantia nigra and mesencephalic tegmentum (SN-T) on DWI and younger age were significantly associated with higher ICP.
Conclusions:
- Increased ICP is prevalent in about one-third of severe TBI patients with DAI.
- MRI-based lesion localization in the central mesencephalon (SN-T) and patient age are predictive factors for elevated ICP.
- MR imaging findings may assist in predicting increased ICP in DAI patients, guiding clinical management.
Related Concept Videos
03:12Freezing Point Depression and Boiling Point Elevation
The boiling point of a liquid is the temperature at which its vapor pressure is equal to ambient atmospheric pressure. Since the vapor pressure of a solution is lowered due to the presence of nonvolatile solutes, it stands to reason that the solution’s boiling point will subsequently be increased. Vapor pressure increases with temperature, and so a solution will require a higher temperature than will pure solvent to achieve any given vapor pressure, including one...
01:12Diffusion
01:21Diffusion
01:25The Central Dogma
01:20Elevation of Intermediate Points on Vertical Curves
02:16Measures of Central Tendency