Diffusion Weighted MR Imaging in Diffuse Axonal Injury

Ilankumaran, C N (2013) Diffusion Weighted MR Imaging in Diffuse Axonal Injury. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION: Head Injury is one of the leading causes of disability and death in Middle Ages in Head Injury and in our country1, about fifty thousand people loose their lives and another 80000 are disabled because of Traumatic Brain Injury. Head injury involves young people in their productive part of their life. Loss of life and rehabilitation of severely disabled victims costs a lot of money and incurs a significant economic burden to the family and country. One of the WHO report mentioned 3.5 million deaths all over the world in a year, due to injury, among them 700,000 were due to road accidents. The same report mentioned that 1.5 million people required medical care. Nakajima et al, reported 5000 billion US dollars being the medical bills and rehabilitation cost. This is a tremendous financial loss due to accidents. India being a developing country increasing accidents not only results in loss of young life, but also damage to the family and financial burden Currently number of deaths due to the road accidents in India are over 60,000 and large number of deaths do occur due to various other injuries. Ramamurthy quoted Rs. 350 cores financial loss per year, due to accidents. The figure is higher at present. AIMS AND OBJECTIVES: 1. To study the usefulness of Diffusion Weighted MR Imaging (DWI) in assessing the prognosis of patients with Diffuse Axonal Injury (DAI). 2. An attempt to understand the significance of various images and signs in DWI MRI of DAI Patients from neurosurgical perspectives. 3. To enable the neurologists and neurosurgeons to understand and correlate the varied clinical manifestations and findings of images and to predict the outcome based on MR sequences. 4. To study about various modes of injuries that are associated with DAI 5. To study about the variations in MRI findings depending on the duration between Time of Injury and Time of MRI. 6. To correlate the duration of LOC, site of lesion, GCS, GOS in DAI with DW sequence of MRI. MATERIALS AND METHODS: The study was done in 48 patients who had been treated for Diffuse Axonal Injuries at Dept .of Neurosurgery, Madras Institute of Neurology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai between August 2010 and February 2013. This was a prospective study and included only when the relatives had given informed consent for taking part in the study. Inclusion Criteria All patients having recent closed head injury with GCS Score 12 and below with normal CT Scan Brain i.e. -severe and moderate head injury patients irrespective of mode of injury are included. Exclusion Criteria: The following patients were excluded • An inability to stay for one hour for MR imaging, • Contraindications for MR imaging, • Poly trauma, • The time delay between trauma and admission exceeding 48 hours, • Patients who had definite lesion in CT Scan Brain, • Patients who underwent surgery, • Images with significant Motion artifacts. CONCLUSION: Diffuse Axonal Injuries occur with motor vehicle accidents due to acceleration deceleration and rotational forces acting on the brain during impact. Patient with moderate and severe injuries according to GCS Scoring system had poor Glasgow Outcome scale. Brain Stem Lesions has poor outcome either death or persistent vegetative state probably due to shearing of tracts. Corpus Callosum lesions took a longer time to recover from LOC and are associated with lower Glasgow outcome scores In future, when supplemented with Diffusion tensor imaging and tractography, neuronal injuries can be analysed well. • Road Traffic Accidents are more often associated with Diffuse Axonal Injuries than Assaults and Accidental Falls. • Day of Imaging had no correlation with the findings or Outcome. • Lesions in Brain Stem and Corpus Callosum were associated with poor GCS on Admission. • Lesions in Brain Stem and Corpus Callosum were associated with Longer period of Loss of Consciousness. • Lesions in Brain Stem and Corpus Callosum were associated with poor Outcome as per GOS. • DWI is an eye opener for DAI analyzing the DAI.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Diffusion Weighted MR Imaging, Diffuse Axonal Injury.
Subjects: MEDICAL > Neuro Surgery
Depositing User: Subramani R
Date Deposited: 12 Feb 2020 01:54
Last Modified: 12 Feb 2020 01:54
URI: http://repository-tnmgrmu.ac.in/id/eprint/11915

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