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Early computed tomography for acute post-traumatic diffuse axonal injury: a systematic review

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Abstract

Purpose

Diffuse axonal injury (DAI) is the rupture of multiple axons due to acceleration and deceleration forces during a closed head injury. Most traumatic brain injuries (TBI) have some degree of DAI, especially severe TBI. Computed tomography (CT) remains the first imaging test performed in the acute phase of TBI, but has low sensitivity for detecting DAI, since DAI is a cellular lesion. The aim of this study is to search in the literature for CT signs, in the first 24 h after TBI, that may help to differentiate patients in groups with a better versus worst prognosis.

Methods

We searched for primary scientific articles in the PubMed database, in English, indexed since January 1st, 2000.

Results

Five articles were selected for review. In the DAI group, traffic accidents accounted 70% of the cases, 79% were male, and the mean age was 41 years. There was an association between DAI and intraventricular hemorrhage (IVH) and traumatic subarachnoid hemorrhage (tSAH); an association between the IVH grade and number of corpus callosum lesions; and an association between blood in the interpeduncular cisterns (IPC) and brainstem lesions.

Conclusion

In closed TBI with no tSAH, severe DAI is unlikely. Similarly, in the absence of IVH, any DAI is unlikely. If there is IVH, patients generally are clinically worse; and the more ventricles affected, the worse the prognosis.

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Funding

No funding was received for this research. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial (such as honoraria; educational grants; participation in speakers’ bureaus; memberships, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interests (such as personal or professional relationships, affiliations, knowledge or beliefs) pertaining to the subject matter or materials discussed in this manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Gaffrée e Guinle University Hospital, School of Medicine, Federal University of Rio de Janeiro State, 775 Mariz e Barros Street, Rio de Janeiro, RJ, Brazil

    Giovana Figueira Rodrigues Vieira & José Fernando Guedes Correa

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  1. Giovana Figueira Rodrigues Vieira
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  2. José Fernando Guedes Correa
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Correspondence to Giovana Figueira Rodrigues Vieira.

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Figueira Rodrigues Vieira, G., Guedes Correa, J.F. Early computed tomography for acute post-traumatic diffuse axonal injury: a systematic review. Neuroradiology 62, 653–660 (2020). https://doi.org/10.1007/s00234-020-02383-2

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