[One-year follow-up study of patients with severe head injury; comparison of outcomes for focal and diffuse brain injuries].
Forty patients with severe head injury were classified on the basis of initial CT findings into 2 groups of focal injury (n = 20, mean age = 55.2 years), and diffuse injury (n = 20, mean age = 45.0 years). Glasgow Outcome Scale (GOS) status at 2 post-injury intervals (at discharge and 1 year after injury) of the 2 groups were compared and prognostic factors examined. At discharge (less than 3 months after injury), there were slight differences between the 2 groups in GOS score distribution, with nearly half of the patients in each group being independent. One year after injury, mean GOS score of the focal injury group was relatively more favorable, with about 60% of patients being independent, while no significant improvement was observed in the diffuse injury group. With the exception of brainstem signs, in both groups, the parameters of type of lesion detected on initial CT, modality of treatment, patient age, and operative timing all proved of little prognostic value. Brainstem injury due to intracranial mass lesions or postoperative brain edema was presumably a critical factor affecting prognosis in the focal injury group, while both primary and secondary brainstem injuries could have been major factors affecting prognosis in the diffuse injury group. In the prognosis of patients with severe head injuries, not only the parameter of initial CT findings but also time course of changes in brainstem signs, serial CT findings, MRI, and electrophysiological analyses such as motor evoked response should be considered.
Honma
Y
Y
Department of Neurological Surgery, Kagawa Medical School.
Ogawa
T
T
Kawai
N
N
Kagawa
M
M
Kuniyoshi
T
T
Ito
T
T
Nagao
S
S
Ohmoto
T
T
D000367:Age Factors; D000368:Aged; D001930:Brain Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D001933:Brain Stem / Q000293:injuries*; D006259:Craniocerebral Trauma / Q000175:diagnosis*; D005071:Evoked Potentials; D005500:Follow-Up Studies; D006407:Hematoma, Epidural, Cranial / Q000175:diagnosis; D006801:Humans; D009044:Motor Cortex / Q000503:physiopathology; D011379:Prognosis; D014057:Tomography, X-Ray Computed