Post-traumatic disorders of consciousness: neuroimaging studies in the recovery process

Authors

  • Oleksandr V. Kulyk Scientific and Practical Center for Neurorehabilitation «Nodus», Brovary, Ukraine

DOI:

https://doi.org/10.25305/unj.159016

Keywords:

traumatic brain injury, coma, post-traumatic disorders of consciousness, computed tomography, neurorehabilitation

Abstract

Purpose. Identify interconnectedness of the results of computed tomographic studies in patients at different stages of post-coma post-traumatic recovery of consciousness in the process of rehabilitation treatment.

Materials and methods. The results of a study of 220 patients with traumatic post-coma disorders of consciousness were analyzed. On average, three CT examinations were performed in each patient within 12 months from the time of severe traumatic brain injury; 855 diagnostic examinations in total.

Results. The features of post-traumatic focal and diffuse changes in the brain parenchyma have proved to be informative indicators of brain CT at different stages of consciousness recovery. Most patients were diagnosed with focal post-traumatic changes of moderate severity, which were combined with diffuse changes of mild and moderate severity, and it was they who demonstrated solid dynamics of consciousness recovery to the highest possible level. The calculation of correlation dependencies using the logarithmic scale (Log10) was performed.

Conclusions. As a result of the calculation of correlation dependencies we identified the greatest significance of the severity of diffuse post-traumatic changes for the prediction of reaching higher levels of consciousness or staying in a vegetative state, and solid dynamics of consciousness recovery to the highest possible level in a group of patients with diagnosed focal post-traumatic changes of moderate severity combined with diffuse changes of mild and moderate severity were determined in the course of research.

References

1. Steppacher I, Kaps M, Kissler J. Will time heal? A long-term follow-up of severe disorders of consciousness. Ann Clin Transl Neurol. 2014 Jun;1(6):401-8. [CrossRef] [PubMed] [PubMed Central]

2. Giacino JT, Ashwal S, Childs N, Cranford R, Jennett B, Katz DI, Kelly JP, Rosenberg JH, Whyte J, Zafonte RD, Zasler ND. The minimally conscious state: definition and diagnostic criteria. Neurology. 2002 Feb 12;58(3):349-53. [CrossRef] [PubMed]

3. Andrews K, Murphy L, Munday R, Littlewood C. Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit. BMJ. 1996 Jul 6;313(7048):13-6. [CrossRef] [PubMed] [PubMed Central]

4. Voss A. Standard der neurologischen-neurochirurgischen frührehabilitation. Ein konzept der arbeitsgemeinschaft neurologisch-neurochirurgische frührehabilitation. In: v.Wild K, Janzik HH, editors. Spectrum der neurorehabilitation: frührehabilitation; rehabilitation von kindern und jugendlichen. Bern, Switzerland: Zuckerschwerdt; 1993. p. 112-120. German.

5. Yao J, Wang LV. Photoacoustic Brain Imaging: from Microscopic to Macroscopic Scales. Neurophotonics. 2014 May 28;1(1). pii: 1877516. [CrossRef] [PubMed] [PubMed Central]

6. Soleimani M, Bayford RH. New and emerging tomographic imaging techniques in medical and industrial applications. Introduction. Philos Trans A Math Phys Eng Sci. 2009 Aug 13;367(1900):3017-9. [CrossRef] [PubMed]

7. Conde V, Andreasen SH, Petersen TH, Larsen KB, Madsen K, Andersen KW, Akopian I, Madsen KH, Hansen CP, Poulsen I, Kammersgaard LP, Siebner HR. Alterations in the brain's connectome during recovery from severe traumatic brain injury: protocol for a longitudinal prospective study. BMJ Open. 2017 Jun 14;7(6):e016286. [CrossRef] [PubMed] [PubMed Central]

8. Matyash MN. Sovremennyye tomograficheskiye metody vizualizatsii izmeneniy v otdalennom periode zakrytoy cherepno-mozgovoy travmy. Promeneva Diahnostyka, Promeneva Terapiya. 2011;(3-4):11-15. Russian. http://nbuv.gov.ua/UJRN/Pdpt_2011_3-4_5

9. Kornienko VN, Potapov AA, Pronin YuN, Zakharova NE. Diagnostic capabilities of computed and magnetic resonance imaging for traumatic brain injury. In: Potapov AA, Likhterman LB, editors. Evidence-based neurotraumatology. Moscow: Burdenko Neurosurgery Institute; 2003. p. 408-463. Russian.

10. Kukunja LA. Three-dimensional imaging in computed tomography: Future prospects. Ukrainian Medical Journal. 2000;3(17):84-86. Russian. https://www.umj.com.ua/article/2161/

11. Greenberg MS, Arredondo N. Handbook of neurosurgery. New York: Thieme; 2001.

12. Andriessen TM, Jacobs B, Vos PE. Clinical characteristics and pathophysiological mechanisms of focal and diffuse traumatic brain injury. J Cell Mol Med. 2010 Oct;14(10):2381-92. [CrossRef] [PubMed] [PubMed Central]

13. Cremer OL, Moons KG, van Dijk GW, van Balen P, Kalkman CJ. Prognosis following severe head injury: Development and validation of a model for prediction of death, disability, and functional recovery. J Trauma. 2006 Dec;61(6):1484-91. [CrossRef] [PubMed]

14. Katz DI, Alexander MP. Traumatic brain injury. Predicting course of recovery and outcome for patients admitted to rehabilitation. Arch Neurol. 1994 Jul;51(7):661-70. [CrossRef] [PubMed]

15. Pickard J, Chir M, Coleman M, Aigbirhio F, Carpenter TA, Owen A. Head injury: from the Glasgow Coma Scale to quo vadis. Clin Neurosurg. 2006;53:53-7. [PubMed]

16. Dobrokhotova TA, Grindel OM, Bragin NN, Potapov AA, Sharova EV, Knyazeva NA. Recovery of consciousness after prolonged coma in patients with severe traumatic brain injury. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 1985;85(5):720-6. Russian.

17. Puras JuV, Grigorieva EV. The neurovisualization methods in diagnostics of head injury. Part 1. Computer tomography and magnetic resonance imaging. Russian Journal of Neurosurgery. 2014;(2):7-16. Russian. [CrossRef]

18. Currie S, Saleem N, Straiton JA, Macmullen-Price J, Warren DJ, Craven IJ. Imaging assessment of traumatic brain injury. Postgrad Med J. 2016 Jan;92(1083):41-50. [CrossRef] [PubMed]

19. Koval GYu, Sivachenko TP, Myasov DS. Radiation Diagnostics. Kyiv: Medytsyna Ukrayiny; 2009. Ukrainian.

20. Levin HS, Saydjari C, Eisenberg HM, Foulkes M, Marshall LF, Ruff RM, Jane JA, Marmarou A. Vegetative state after closed-head injury. A Traumatic Coma Data Bank Report. Arch Neurol. 1991 Jun;48(6):580-5. [PubMed]

21. Danze F, Brule JF, Haddad K. Chronic vegetative state after severe head injury: clinical study; electrophysiological investigations and CT scan in 15 cases. Neurosurg Rev. 1989;12 Suppl 1:477-99. [CrossRef] [PubMed]

22. Kinney HC, Samuels MA. Neuropathology of the persistent vegetative state. A review. J Neuropathol Exp Neurol. 1994 Nov;53(6):548-58. [CrossRef] [PubMed]

Published

2019-03-23

How to Cite

Kulyk, O. V. (2019). Post-traumatic disorders of consciousness: neuroimaging studies in the recovery process. Ukrainian Neurosurgical Journal, 25(1), 56–62. https://doi.org/10.25305/unj.159016

Issue

Section

Original articles