Traumatic midline subarachnoid hemorrhage on initial computed tomography as a marker of severe diffuse axonal injury

Daddy Mata-Mbemba, Shunji Mugikura, Atsuhiro Nakagawa, Takaki Murata, Kiyoshi Ishii, Shigeki Kushimoto, Teiji Tominaga, Shoki Takahashi, Kei Takase

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective: The objective of this study was to test the hypothesis that midline (interhemispheric or perimesencephalic) traumatic subarachnoid hemorrhage (tSAH) on initial CT may implicate the same shearing mechanism that underlies severe diffuse axonal injury (DAI). Methods: The authors enrolled 270 consecutive patients (mean age [± SD] 43 ± 23.3 years) with a history of head trauma who had undergone initial CT within 24 hours and brain MRI within 30 days. Six initial CT findings, including intraventricular hemorrhage (IVH) and tSAH, were used as candidate predictors of DAI. The presence of tSAH was determined at the cerebral convexities, sylvian fissures, sylvian vallecula, cerebellar folia, interhemispheric fissure, and perimesencephalic cisterns. Following MRI, patients were divided into negative and positive DAI groups, and were assigned to a DAI stage: 1) stage 0, negative DAI; 2) stage 1, DAI in lobar white matter or cerebellum; 3) stage 2, DAI involving the corpus callosum; and 4) stage 3, DAI involving the brainstem. Glasgow Outcome Scale-Extended (GOSE) scores were obtained in 232 patients. Results: Of 270 patients, 77 (28.5%) had DAI; tSAH and IVH were independently associated with DAI (p < 0.05). Of tSAH locations, midline tSAH was independently associated with both overall DAI and DAI stage 2 or 3 (severe DAI; p < 0.05). The midline tSAH on initial CT had sensitivity of 60.8%, specificity of 81.7%, and positive and negative predictive values of 43.7% and 89.9%, respectively, for severe DAI. When adjusted for admission Glasgow Coma Score, the midline tSAH independently predicted poor GOSE score at both hospital discharge and after 6 months. Conclusions: Midline tSAH could implicate the same shearing mechanism that underlies severe DAI, for which midline tSAH on initial CT is a probable surrogate.

Original languageEnglish
Pages (from-to)1317-1324
Number of pages8
JournalJournal of neurosurgery
Volume129
Issue number5
DOIs
Publication statusPublished - 2018 Nov

Keywords

  • Computed tomography
  • Diffuse axonal injury
  • Early outcome
  • Long-term outcome
  • Trauma
  • Traumatic brain injury
  • Traumatic subarachnoid hemorrhage

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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