| [PMID]: | 28069157 |
| [Au] Autor: | Woischneck D; Schmitz B; Kapapa T |
| [Ad] Endereço: | Department of Neurosurgery, Hospital Landshut, Robert-Koch-Straße 1, 84034 Landshut, Germany. Electronic address: Dieter.Woischneck@klinikum-landshut.de. |
| [Ti] Título: | MRI detection of cerebral lesions in post-traumatic anisocoria: specificity and prognostic significance. |
| [So] Source: | Clin Radiol;72(5):426.e7-426.e15, 2017 May. |
| [Is] ISSN: | 1365-229X |
| [Cp] País de publicação: | England |
| [La] Idioma: | eng |
| [Ab] Resumo: | AIM: To identify whether increased numbers of brainstem lesions are found in the presence of a post-traumatic pupillary function disturbance and classify them anatomically. MATERIALS AND METHODS: In this study, a diagnostic magnetic resonance imaging (MRI) examination was performed within 8 days after traumatic brain injury (TBI) in patients who had been unconscious for more than 24 hours post-TBI. The Glasgow Outcome Scale was evaluated 6 months after TBI. The data obtained from 140 consecutively enrolled patients between 2005 and 2011 were analysed. The clinical study parameter comprised the development of post-traumatic anisocoria at least once over the course between onset of trauma and diagnostic MRI, as a yes/no decision. Significance was presumed at p≤0.05. RESULTS: A total of 57 patients (41%) were found to have a lesion at MRI without involvement of the brainstem; in 83 (59%) the brainstem was (multiple) affected. Of the latter, 66 (46%) of patients had lesions in the midbrain, 38 (27%) in the pons, and seven (5%) in the medulla oblongata. By the time of MRI, anisocoria had been diagnosed in 45 (32%) patients. Mortality was highest, at 58%, in patients with anisocoria and a midbrain lesion, whilst it was 23% in those with anisocoria and no lesion in the midbrain. Mortality was 33% in relation to a midbrain lesion without anisocoria. CONCLUSION: Overall, the study demonstrated that there is a significant correlation between midbrain lesions and post-traumatic anisocoria in unconscious trauma patients. A brainstem lesion in this case can be assumed to be a pathomorphological correlate of anisocoria. The rate of damage to the midbrain was approximately 50% in cases of transient anisocoria. It can be assumed in this situation that there are functional disorders of the peripheral oculomotor nerve or identifiable/unidentifiable lesions of the brainstem. |
| [Mh] Termos MeSH primário: |
Anisocoria/diagnóstico por imagem
Anisocoria/etiologia
Lesões Encefálicas Traumáticas/complicações
Imagem por Ressonância Magnética/métodos
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| [Mh] Termos MeSH secundário: |
Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Anisocoria/patologia
Tronco Encefálico/diagnóstico por imagem
Tronco Encefálico/patologia
Criança
Pré-Escolar
Feminino
Seres Humanos
Masculino
Mesencéfalo/diagnóstico por imagem
Mesencéfalo/patologia
Meia-Idade
Prognóstico
Estudos Prospectivos
Sensibilidade e Especificidade
Adulto Jovem
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| [Pt] Tipo de publicação: | JOURNAL ARTICLE |
| [Em] Mês de entrada: | 1704 |
| [Cu] Atualização por classe: | 170414 |
[Lr] Data última revisão:
| 170414 |
| [Sb] Subgrupo de revista: | IM |
| [Da] Data de entrada para processamento: | 170111 |
| [St] Status: | MEDLINE |
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