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Primary brain stem lesions caused by closed head injuries
T Hashimoto1, N Nakamura, K E Richard
1Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan.
Neurosurgical Review
|January 1, 1993
Summary
Primary brain stem lesions, often from traffic accidents, occur at impact in 8.8% of severe head injuries. Prognosis is poor, especially with associated diffuse shearing injuries.
Area of Science:
- Neuroscience
- Trauma Surgery
- Radiology
Background:
- Traumatic brain stem lesions are classified as primary (at impact) or secondary (due to mass effect).
- Primary brain stem lesions are often associated with severe head injuries and altered consciousness.
Purpose of the Study:
- To identify the incidence and characteristics of primary brain stem lesions in patients with severe head injuries.
- To differentiate primary from secondary brain stem lesions using initial CT scans.
Main Methods:
- Retrospective analysis of 239 patients with severe head injury and disturbed consciousness.
- Immediate CT scans were performed to identify brain stem lesions and associated injuries.
Main Results:
- Primary brain stem lesions were identified in 21 of 239 patients (8.8%), predominantly from traffic accidents.
- Most cases (16/21) had associated diffuse shearing injuries; 5 had isolated brain stem lesions.
- Lesions were primarily located dorsally in the midbrain, distinct from secondary lesions.
Conclusions:
- Primary brain stem lesions are a distinct entity in severe head trauma, often linked to shearing mechanisms.
- The prognosis for primary brain stem lesions is generally poor, though isolated lesions may fare better.