Intraventricular hemorrhage on computed tomography and corpus callosum injury on magnetic resonance imaging in patients with isolated blunt traumatic brain injury.
OBJECTIVE
Intraventricular hemorrhage (IVH) is widely regarded as one element of a complex involving severe blunt traumatic brain injury (TBI); corpus callosum injury (CCI) is recently considered to be one factor associated with poor outcome in patients with TBI. Although postmortem studies have focused on the relationship between IVH and CCI, there have been few investigations of IVH evidenced on CT scans as a predictor of CCI evidenced on MRI.


METHODS
The authors retrospectively reviewed prospectively collected data from 371 patients with blunt TBI, without trauma to the face, chest, abdomen, extremities, or pelvic girdle, requiring immediate therapeutic intervention. Their aim was to investigate whether IVH found on CT predicts CCI on MRI. Clinical and radiological data were collected between June 2003 and February 2011. First, the authors classified patients into groups of those with CCI and those without CCI, and they compared clinical and radiological findings between them. Then, they investigated prognostic factors that were related to the development of disability at 6 months after injury. The outcomes at 6 months after injury were evaluated using the Extended Glasgow Outcome Scale (GOS-E). Finally, the authors evaluated the correlation between the severity of the IVH on CT and the number of CCI lesions on MRI. The severity of the IVH was defined by the number of ventricles in which IVH was seen, and the number of CCI lesions was counted on the MRI study.


RESULTS
On multivariate logistic regression analysis, Glasgow Coma Scale score less than 9 (OR 2.70 [95% CI 1.10-6.27]), traffic accident (OR 2.59 [95% CI 1.37-4.93]), and IVH on CT (OR 3.31 [95% CI 1.25-8.49]) were significantly related to CCI. Multivariate analysis also showed that older age (p = 0.0001), male sex (OR 3.26 [95% CI 1.46-8.08], p = 0.0065), Glasgow Coma Scale score less than 9 (OR 8.27 [95% CI 3.39-21.4], p < 0.0001), evidence of IVH on CT (OR 4.09 [95% CI 1.45-11.9], p = 0.0081), and evidence of CCI on MRI (OR 8.32 [95% CI 3.89-18.8], p < 0.0001) were associated with future development of disability (GOS-E score ≤ 6). Furthermore, simple regression analysis revealed the existence of a strong correlation between the severity of IVH and the number of CCI lesions (r = 0.0668, p = 0.0022).


CONCLUSIONS
The authors' results suggest that evidence of IVH on CT may indicate CCI, which can lead to disability in patients with isolated blunt TBI.
Department of Neurosurgery, St. Luke’s International Hospital, Chuo-ku, Tokyo, Japan. mahide@luke.or.jp
Hidetoshi
H
Matsukawa
Masaki
M
Shinoda
Motoharu
M
Fujii
Osamu
O
Takahashi
Atsushi
A
Murakata
Daisuke
D
Yamamoto
Sosuke
S
Sumiyoshi
Ryoichi
R
Ishikawa
D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000175:diagnosis*; D020208:Brain Injury, Chronic / Q000175:diagnosis; D002540:Cerebral Cortex / Q000293:injuries*; D020202:Cerebral Hemorrhage, Traumatic / Q000175:diagnosis*; D002552:Cerebral Ventricles / Q000473:pathology*; D003337:Corpus Callosum / Q000293:injuries*; D020833:Diffuse Axonal Injury / Q000175:diagnosis; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000175:diagnosis*