Intracranial pressure elevations in diffuse axonal injury : association with nonhemorrhagic MR lesions in central mesencephalic structures
Abu Hamdeh, Sami ; Marklund, Niklas LU
; Lewén, Anders
; Howells, Tim
; Raininko, Raili
; Wikström, Johan
and Enblad, Per
(2019)
In Journal of Neurosurgery
131(2).
p.604-611
- Abstract
OBJECTIVEIncreased 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.METHODSFifty-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... (More)
OBJECTIVEIncreased 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.METHODSFifty-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.RESULTSAll 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.CONCLUSIONSIncreased 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.
(Less)
- author
- Abu Hamdeh, Sami
; Marklund, Niklas
LU
; Lewén, Anders
; Howells, Tim
; Raininko, Raili
; Wikström, Johan
and Enblad, Per
- publishing date
- 2019
- type
- Contribution to journal
- publication status
- published
- in
- Journal of Neurosurgery
- volume
- 131
- issue
- 2
- pages
- 604 - 611
- publisher
- American Association of Neurosurgeons
- external identifiers
-
- scopus:85073644879
- pmid:30215559
- ISSN
- 0022-3085
- DOI
- 10.3171/2018.4.JNS18185
- language
- English
- LU publication?
- no
- id
- 852355ff-bf4d-4545-ba65-e443ccb43f7e
- date added to LUP
- 2019-02-05 11:42:21
- date last changed
- 2024-07-09 05:50:40
@article{852355ff-bf4d-4545-ba65-e443ccb43f7e,
abstract = {{<p>OBJECTIVEIncreased 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.METHODSFifty-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.RESULTSAll 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.CONCLUSIONSIncreased 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.</p>}},
author = {{Abu Hamdeh, Sami and Marklund, Niklas and Lewén, Anders and Howells, Tim and Raininko, Raili and Wikström, Johan and Enblad, Per}},
issn = {{0022-3085}},
language = {{eng}},
number = {{2}},
pages = {{604--611}},
publisher = {{American Association of Neurosurgeons}},
series = {{Journal of Neurosurgery}},
title = {{Intracranial pressure elevations in diffuse axonal injury : association with nonhemorrhagic MR lesions in central mesencephalic structures}},
url = {{http://dx.doi.org/10.3171/2018.4.JNS18185}},
doi = {{10.3171/2018.4.JNS18185}},
volume = {{131}},
year = {{2019}},
}