Late CT findings and final outcome of patients with blunt brain trauma

Purpose: To evaluate the correlation of a number of indexes of cerebral atrophy observed in CT scans after severe blunt trauma with subsequent neuro-psychological status. Patients-Methods: The study group comprised 9 previously healthy men, 17-58 years old who had severe blunt trauma of the brain (initial GCS scores of 8 or less). All had sustained a hematoma (subdural or epidural) drainage. Their cognitive and behavioral status were evaluated when the patients were discharged from the hospital and 1 year later. The GOS classification was SD for all patients. The CT scans were performed with 5 and 10 mm axial slices 3-6 months after trauma. The following indexes were measured; a) septum-caudate distance (SCD), b) cella media distance (CMD), c) third ventricle width (TVW), d) cella media index (CMI = maximal external width of the skull/CMD), e) fourth ventricle width (FVW), and f) sulcal score (sum of the widths of the four widest sulci seen in the upper three sections). The control group consisted of 44 age- and sex-matched patients who had a negative CT scan, for epileptic seizures. The controls had no history of alcohol consumption, head trauma, demyelination, hypertension or diabetes. In addition we studied a second control group consisted of 6 age- and sex-matched patients who had a GOS classification GR/MD 6 months after severe blunt trauma of the brain (initial scores on GCS of 8 or less). Results: A high correlation was found between the TVW and outcome (p < 0.01) of the patients and a weak correlation concerning the CMD (p = 0.05). No statistical correlation was found between the various indexes between patients and the second control group. The prognostic value of the TVW was superior to that of any other index studied. Conclusion: The TVW is a useful CT prognostic index in cases of diffuse brain trauma. It indicates diencephalic atrophy, caused either by diffuse axonal injury or by hypoxia. It may indicate a role of diencephalic structures in higher cortical functions.