Öz
Amaç:
Kontüzyo serebri, en sık karşılaşılan travmatik beyin yaralanması olması ve ömür boyu süren fiziksel, bilişsel ve psikolojik bozukluklara yol açabilmesi nedeniyle önem taşımaktadır. Diğer tüm kraniyoserebral travma tiplerinde olduğu gibi kontüzyon serebride de prognozun belli kriterlere bağlanması objektif yaklaşımlarla vakit geçirmeden daha efektif tedavi yöntemlerinin belirlenmesini sağlayabilir.
Yöntem:
Acil poliklinikte kontüzyon serebri saptanılarak yatırılan, lezyonu cerrahi müdahale gerektirmeyen 105 olgu araştırıldı. Demografik değişkenler, Glasgow koma skalası (GKS) skoru, radyografik bulgular, eşlik eden travmalar, kraniyal bilgisayarlı tomografide (BT) saptanılan kontüzyonların tipi, sayısı, ile oluşturduğu orta hat şiftine göre sonuçları bir aylık dönemde prognoz tayininde yol gösterici olarak değerlendirildi.
Bulgular:
Çalışmadaki olguların 25’i kadın, 80’i erkek olup ortalama yaş 37 idi. Trafik kazalarının kontüzyon serebri oluşumunda ilk sırayı aldığı dikkati çekti. İlerleyen yaşın mortalite üzerinde belirgin etkisi olduğu, cins faktörünün ise prognoza etkisinin olmadığı görüldü. GKS skorunda yer alan motor postür, pupil ışık reaksiyonu, kraniyal BT’deki kontüzyonun sayısı ve eşlik eden subdural hematom (SDH) prognostik açıdan yol gösterici idi. Kranial fraktürün ve orta hat şiftinin prognoza etkisinin olmadığı görüldü.
Sonuç:
İleri yaş, düşük GKS skoru, anormal motor cevap, anormal pupil ışık reaksiyonu, birlikte diğer sistem travmalarının bulunması, kontüzyonun multipl olması ve beraberinde SDH bulunması olguların prognozunu kötü yönde etkilemekteydi.
Anahtar Kelimeler: Serebral kontüzyon, kafa travması, bilgisayarlı tomografi, Glasgow koma skalası, intraparankimal kanama, prognoz, travma, travmatik beyin yaralanması
Kaynakça
Bodanapally UK, Sours C, Zhuo J, Shanmuganathan K. Imaging of Traumatic Brain Injury. Radiol Clin North Am 2015;53:695-715.
Carnevale JA, Segar DJ, Powers AY, Shah M, Doberstein C, Drapcho B, et al. Blossoming contusions: identifying factors contributing to the expansion of traumatic intracerebral hemorrhage. J Neurosurg 2018;129:1305-1316.
Hardman JM, Manoukian A. Pathology of head trauma. Neuroimaging Clin N Am 2002;12:175-187.
Hilmer LV, Park KB, Vycheth I, Wirsching M. Cerebral Contusion: An Investigation of Etiology, Risk Factors, Related Diagnoses, and the Surgical Management at a Major Government Hospital in Cambodia. Asian J Neurosurg 2018;13:23-30.
Iaccarino C, Schiavi P, Picetti E, Goldoni M, Cerasti D, Caspani M, et al. Patients with brain contusions: predictors of outcome and relationship between radiological and clinical evolution. J Neurosurg 2014;120:908-918.
Koo AH, LaRoque RL. Evaluation of head trauma by computed tomography. Radiology 1977;123:345-50.
Kurland D, Hong C, Aarabi B, Gerzanich V, Simard JM. Hemorrhagic progression of a contusion after traumatic brain injury: a review. J Neurotrauma 2012;29:19-31.
MRC CRASH Trial Collaborators, Perel P, Arango M, Clayton T, Edwards P, Komolafe E, et al. Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ 2008;336:425-429.
Rehman L, Afzal A, Aziz HF, Akbar S, Abbas A, Rizvi R. Radiological Parameters to Predict Hemorrhagic Progression of TraumaticContusional Brain Injury. J Neurosci Rural Pract 2019;10:212-217.
Saatman KE, Duhaime AC, Bullock R, Maas AI, Valadka A, Manley GT. Workshop Scientific Team and Advisory Panel Members. Classification of traumatic brain injury for targeted therapies. J Neurotrauma 2008;25:719-738.
Steyerberg EW, Mushkudiani N, Perel P, Butcher I, Lu J, McHugh GS, et al. Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristics. PLoS Med 2008;5:e165;discussion e165.
Umerani MS, Abbas A, Sharif S. Traumatic brain injuries: Experience from a tertiary care centre in Pakistan. Turk Neurosurg 2014;24:19-24.
Alahmadi H, Vachhrajani S, Cusimano MD. The natural history of brain contusion: an analysis of radiological and clinical progression. J Neurosurg 2010;112:1139-1145.
Cepeda S, Gómez PA, Castaño-Leon AM, Martínez-Pérez R, Munarriz PM, Lagares A. Traumatic Intracerebral Hemorrhage: Risk Factors Associated with Progression.J Neurotrauma 2015;32:1246-1253.
Ratnaike TE, Hastie H, Gregson B, Mitchell P. The geometry of brain contusion: relationship between site of contusion and direction of injury. Br J Neurosurg 2011;25:410-413.
Lobato RD, Cordobes F, Rivas JJ, de la Fuente M, Montero A, Barcena A, et al. Outcome from severe head injury related to the type of intracranial lesion. A computerized tomography study. J Neurosurg 1983;59:762-774.
Miller JD, Butterworth JF, Gudeman SK, Faulkner JE, Choi SC, Selhorst JB, et al. Further experience in the management of severe head injury. J Neurosurg 1981;54:289-299.
Narayan RK, Greenberg RP, Miller JD, Enas GG, Choi SC, Kishore PR, et al. Improved confidence of outcome prediction in severe head injury. A comparative analysis of the clinical examination, multimodality evoked potentials, CT scanning, and intracranial pressure. J Neurosurg 1981;54:751-762.
Jacobs B, Beems T, Stulemeijer M, van Vugt AB, van der Vliet TM, Borm GF, et al. Outcome prediction in mild traumatic brain injury: age and clinical variables are stronger predictors than CT abnormalities. J Neurotrauma 2010;27:655-668.
Mushkudiani NA, Engel DC, Steyerberg EW, Butcher I, Lu J, Marmarou A, et al. Prognostic value of demographic characteristics in traumatic brain injury: results from the IMPACT study. J Neurotrauma 2007;24:259-269.
Wong GKC, Ngai K, Poon WS, Zheng VZY, Yu C. Cognitive Outcomes of Patients with Traumatic Bifrontal Contusions. Acta Neurochir 2018;126:63-65.
Wong GK, Tang BY, Yeung JH, Collins G, Rainer T, Ng SC, et al. Traumatic intracerebral haemorrhage: is the CT pattern related to outcome? Br J Neurosurg 2009;23:601-605.
Siegel JH, Gens DR, Mamantov T, Geisler FH, Goodarzi S, MacKenzie EJ. Effect of associated injuries and blood volume replacement on death, rehabilitation needs, and disability in blunt traumatic brain injury. Crit Care Med 1991;19:1252-1265.
Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974;2:81-84.
Jacobs B, Beems T, van der Vliet TM, Diaz-Arrastia RR, Borm GF, Vos PE. Computed tomography and outcome in moderate and severe traumatic brain injury: hematoma volume and midline shift revisited. J Neurotrauma 2011;28:203-215.
Rimel RW, Jane JA. Minor head injury: management and outcome, in Williams RH, Rengachary SS, (editors). 1st ed., Neurosurgery, McGraw-Hill, New York, 1985:1608-1611.
Yue JK, Winkler EA, Puffer RC, Deng H, Phelps RRL, Wagle S, et al. Temporal lobe contusions on computed tomography are associated with impaired 6-month functional recovery after mild traumatic brain injury: a TRACK-TBI study. Neurol Res 2018;40:972-981.
Servadei F, Teasdale G, Merry G. Neurotraumatology Committee of the World Federation of Neurosurgical Societies. Defining acute mild head injury in adults: a proposal based on prognostic factors, diagnosis, and management. J Neurotrauma 2001;18:657-664.
Jennett B, Teasdale G, Braakman R, Minderhoud J, Knill-Jones R. Predicting outcome in individual patients after severe head injury. Lancet 1976;1:1031-1034.
Marshall LF, Bowers SA. Outcome prediction in severe head injury: In Wilkins RH, Rengachary SS (editors). 1st ed., Neurosurgery, Mcgraw Hill, New York, 1985:1605-1608.
Afzali-Hashemi L, Hazewinkel M, Tjepkema-Cloostermans MC, van Putten MJAM, Slump CH. Detection of small traumatic hemorrhages using a computer-generated average human brain CT. J Med Imaging (Bellingham) 2018;5:024004.
Douglas DB, Muldermans JL, Wintermark M. Neuroimaging of brain trauma. Curr Opin Neurol 2018;31:362-370.
Henninger N, Compton RA, Khan MW, Carandang R, Hall W, Muehlschlegel S. ‘‘Don’t lose hope early’’: Hemorrhagic diffuse axonal injury on head computed tomography is not associated with poor outcome in moderate to severe traumatic brain injury patients. J Trauma Acute Care Surg 2018;84:473-482.
Maas AI, Hukkelhoven CW, Marshall LF, Steyerberg EW. Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combinations of computed tomographic predictors. Neurosurgery 2005;57:1173-1182.
Shetty VS, Reis MN, Aulino JM, Berger KL, Broder J, Choudhri AF, et al. ACR Appropriateness Criteria Head Trauma. J Am Coll Radiol 2016;13:668-679.
Chang EF, Meeker M, Holland MC. Acute traumatic intraparenchymal hemorrhage: risk factors for progression in the early post-injury period. Neurosurgery 2006;58:647-656.
Chang EF, Meeker M, Holland MC. Acute traumatic intraparenchymal hemorrhage: risk factors for progression in the early post-injury period. Neurosurgery 2007;61:222-230.
Swanson JO, Vavilala MS, Wang J, Pruthi S, Fink J, Jaffe KM, et al. Association of initial CT findings with quality-of-life outcomes for traumatic brain injury in children. Pediatr Radiol 2012;42:974-981.
Adams JH, Graham DI, Murray LS, Scott G. Diffuse axonal injury due to nonmissile head injury in humans: an analysis of 45 cases. Ann Neurol 1982;12:557-563.
Gennarelli TA, Thibault LE, Adams JH, Graham DI, Thompson CJ, Marcincin RP. Diffuse axonal injury and traumatic coma in the primate. Ann Neurol 1982;12:564-574.
Raj R, Siironen J, Skrifvars MB, Hernesniemi J, Kivisaari R. Predicting outcome in traumatic brain injury: development of a novel computerized tomography classification system (Helsinki computerized tomography score). Neurosurgery 2014;75:632-646.
