Traumatic intracerebral hemorrhage associated with internuclear ophthalmoplegia is uncommon and usually presents itself in combination with diffuse axonal injury or cerebral contusion. On a review of the literatures, there hav been 23 cases of post-traumatic internuclear ophthalmoplegia reported. The authors are reporting a case of pure traumatic unilateral internuclear ophthalmoplegia with Hornor's syndrome caused by traumatic unilateral tegmental hemorrhage without diffusse axonal injury or cerebral contusion. The lesion was diagnosed by magnetic resonance image(MRI) and computed tomography(CT). The clinical feature, mechanism, and prognosis are discussed together with a review of the literatures.
Axons ; Cerebral Hemorrhage, Traumatic ; Contusions ; Diffuse Axonal Injury ; Hematoma* ; Hemorrhage ; Ocular Motility Disorders* ; Prognosis

CT has facilitated early recognition and treatment of focal brain injuries in patients with head trauma. However. CT shows relatively low sensitivity in identifying nonhemorrhagic contusion and injuries of white matter. MR is known to be superior to CT in detection of which matter injuries, such as diffuse axonal injury. MR imaging in 14 cases of diffuse axonal injury on 2.0T was studied. The corpus callosum, especially the body portion, was the most commonly involved site. The lesions ranged from 5 to 20 mm in size with ovoid to elliptical shape. T2WI was the most sensitive pulse sequence in detecting lesions such as white matter degeneration, hemorrhagic and nonhemorrhagic contusion. The lesions were nonspecific as high and low signal intensities on T2WI and T1WI respectively. CT showed white matter abnormality in only 1 case of 14 cases. We propose MR imaging as the primary imaging procedure for the detection of diffuse axonal injury because of its multiplanar capabilities and higher sensitivity.
Brain Injuries ; Contusions ; Corpus Callosum ; Craniocerebral Trauma ; Diffuse Axonal Injury* ; Humans ; Magnetic Resonance Imaging* ; White Matter

Tissue tear hemorrhages(TTHs) have been thought to be visible manifestation of more severe forms of diffuse axonal injury and thus portend a poor prognsis. Computed tomographic scans and magnetic resonance images from 1076 patients with closed head injuries were reviewed;30(3.5%) cases were found to have TTHs. The authors investigated the clinical spectrum of TTHs. No direct relationship could e established between presence of TTHs and the severity and/or outcome from the head injury in this group. Magnetic resonance imaging provided more sensitive information than computed tomography in evaluating TTHs.
Brain* ; Craniocerebral Trauma ; Diffuse Axonal Injury ; Head Injuries, Closed ; Humans ; Magnetic Resonance Imaging

This study was performed in order to compare the functional imaging by 99m Tc-HMPAO brain SPECT with structural neuroimaging by CT or MRI. Eighteen patients with diffuse axonal injury underwent HMPAO brain SPECT(18), CT(9) and MR(14), and neurological status were then evaluated. Seventeen patients(94%) were revealed abnormal SPECT whereas nine patients(50%) demonstrated abnormal CT compared with ten patients(71%) demonstrated abnormal MRI. The neurololgical deficits correlated well with abnormal SPECT lesion except in one case. It is therefore concluded that brain perfusion SPECT is not only more sensitive than CT or MRI, it is also more cost effective and clinically well correlated in diffuse axonal injury patient.
Brain* ; Diffuse Axonal Injury* ; Humans ; Magnetic Resonance Imaging ; Neuroimaging ; Perfusion ; Tomography, Emission-Computed, Single-Photon*

We present a study on hospital stay in 1000 consecutive head injuries. The mean hospital stay and standard deviation were calculated in a given condition according to some variables, such as sex, age, Glasgow Coma Score on admission, skull fracture, CT findings, and treatment. Usually, standard deviation was greater than the mean value in a given condition and hospital stay varied in a wide range, representing that the duration of treatment is related not only to the severity but also various individual properties. Since the associated injuries were variable in location, type and severity, they altered hospital stay greatly. Thus hospital stay was analyzed in patients without associated injuries. Hospital stay was largely dependant on three variables. Low Glasgow Coma Score on admission, presence of intracranial mass lesion or diffuse axonal injury, and operative treatment prolonged hospital stay. Skull fracture also lengthened hospital stay but only in patients without associated injuries. Duration of treatment should be recorded in all medical certificates related to the injury. For the proper estimation of duration of treatment, more reports are needed in this field.
Coma ; Craniocerebral Trauma* ; Diffuse Axonal Injury ; Head* ; Humans ; Length of Stay* ; Skull Fractures

As one type of primary brain injury, diffuse axonal injury (DAI) has specific traumatic mechanisms. The occurence of DAI is close to the loading property, loading manner, structural characteristics of skull, brain tissue and neck. This article demonstrated how the stress and strain varied in brain tissue effected by the load magnitude, load waveform, load frequency, load duration, linear acceleration, rotational acceleration, compounded linear/rotational acceleration, brain tissue, cerebral falx, cerebellar tentorium, skull and neck, and what are the relationships between these factors and the event of DAI.
Animals ; Biomechanical Phenomena ; Brain ; physiology ; Diffuse Axonal Injury ; physiopathology ; Humans ; Neck ; physiology ; Skull ; physiology ; Stress, Mechanical

The study of blink reflexes was carried out to demonstrate the correlations, if there were, between the stage of diffuse axonal injury(DAI) and the abnormality of blink reflexes. The blink reflex was recorded in 20 healthy adult subjects and 22 patients with DAI who were classified according to Adams' classification(DAI I; 7, DAI II; 9 and DAI III; 6). The latencies and amplitudes of R1 and R2 in patients with DAI were compared with those of healthy subjects. The results were as follows; 1) In 20 subjects of patient group, the latencies of R1 were all within a normal range. In 2 subjects, the difference in latencies between the two sides was above 1.4 msec. 2) In 15 subjects, R2 was absent or delayed, and reduced in the size of amplitude in all. Nine were affected bilaterally, and 4 were unilaterally. 3) Seventy one percent of patients in each stage represented abnormal findings. 4) There were no correlations between the DAI stage and the blink reflex. This study demonstrated that the polysynaptic R2 was more profoundly suppressed than the oligosynaptic R1 in a diffuse axonal injury because of a loss or decrease of suprapontine facillitation, which influenced the trigeminal spinal complex and the interneuron of lateral reticular formation.
Adult ; Axons ; Blinking* ; Diffuse Axonal Injury* ; Humans ; Interneurons ; Reference Values ; Reticular Formation

The authors have evaluated retrospectively the distribution and extent of traumatic lesions in brain MRI of 20 diffuse axonal injury(DAI) patients. DAI most commonly involves the white matter of the frontal lobe and posterior half of the corpus callosum. The lesions on MRI were classified according to the modified Adams staging as follows. Stage 0:no lesion identified(3 cases, 15%); Stage 1 :lesions confined to the lobar white matter(4 cases, 20%);Stage 2 : lesions in the lobar white matter and corpus callosum(9 cases, 45%) ; Stage 3: additional lesions in midbrain and upper pons(4 cases, 20%). Correlations between the modified Adams staging and initial posttraumatic consciousness state, presence of focal neurological deficit and the outcome of the patients were observed. Also, the presence of corpus callosum lesions tends to be associated with subarachnoid and/or intraventricular hemorrhage, T2 weighted image was found to be the most sensitive sequence for detection of DAI lesions.
Axons ; Brain ; Consciousness ; Corpus Callosum ; Diffuse Axonal Injury* ; Frontal Lobe ; Hemorrhage ; Humans ; Magnetic Resonance Imaging* ; Mesencephalon ; Retrospective Studies

Atotal of 26 patients diagnosed as diffuse axonal injury(DAI) between Nov. 1993 and Dec. 1995, were evaluated retrospectively with special attention given to MRI findings. In clinical aspects, there was male predominance(1.9:1) with the mean age of 28.5 years. The clinical grades based on the Glasgow coma scale(GCS) score were classified as mild(13-15), moderate(9-12) and severe(3-8). The duration of hospitalization and loss of consciousness(LOC) at admission were well correlated with the severity of clinical status. As regards the outcome of patients, twenty patients(77%) recovered as alert, but three patients(12%) died of sepsis. Short duration of LOC less than one day and young age of less than 10 years were good prognostic factors. The MRI findings of DAI were divided into three grades; in grade 1, there was small scattered lesions in the white matter of the cerebral hemisphere, in grade 2, focal lesion in the corpus callosum, and in grade 3, there was an additional focal lesion in the brain stem. The final outcome of grade 3 was poor, but in grade 2, there was wide spectrum between initial clinical status from alertness to semicoma and relative good result.
Axons* ; Brain Stem ; Cerebrum ; Coma ; Corpus Callosum ; Diffuse Axonal Injury ; Hospitalization ; Humans ; Magnetic Resonance Imaging ; Male ; Retrospective Studies ; Sepsis

A retrospective study 40 patients with moderate or severe diffuse axonal injury which is defined as posttraumatic coma for over 24 hours without mass lesions or ischemic insults was conducted in order to identify prognostic parameters. The sign of hypothalamic damage and motor reactivities of 40 patients were reviewed and compared to the outcome. The results were as follows ; 1) The ratio of male to female was about 3 to 1 and the peak incidence was at the first decade. 2) Of abnormal brain stem signs, fever of central origin was observed at the early posttraumatic phase and correlated with nonrecovery of consciousness(P<0.05). 3) Of abnormal brain stem signs, abnormal ADH secretion was significantly correlated with nonrecovery of consciousness(P<0.005). 4) Abnormal motor reactivity to pain was significantly correlated with nonrecovery of consciousness(P<0.005). 5) In the group of recovery of consciousness, initial Glasgow coma scale in 40 patients with moderate or severe DAI was significantly correlated with their outcome(P<0.005).
Brain Stem ; Coma ; Consciousness ; Diffuse Axonal Injury* ; Female ; Fever ; Glasgow Coma Scale ; Humans ; Incidence ; Male ; Retrospective Studies