Pathophysiology of posttraumatic temporal lobe lesions

Division of Neurosurgery, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Surgical Neurology (Impact Factor: 1.67). 02/2005; 64 Suppl 1:S1:22-9; discussion S1:29. DOI: 10.1016/j.surneu.2004.11.008
Source: PubMed


Posttraumatic parenchymal lesions in the temporal lobe may cause neurologic deterioration. An analysis was made of the natural evolution of this type of lesion, with emphasis on its 2 components: hemorrhage (hyperdense on computed tomography [CT]), and edema and necrosis (hypodense on CT). The clinical repercussions were studied, and the factors that might influence such evolution were investigated.
Forty head-injured patients with temporal lobe lesions admitted within 12 hours after the injury were selected in a prospective manner. Computed tomography scans were systematically repeated within the first 36 hours and at 7 and 30 days postinjury. Factors such as interval between injury and the first CT scan, age, velocity of the injury, alcohol consumption, coagulation abnormalities, and the presence of decompressive measures were compared between the patients that had enlargement of the hemorrhage and those who did not. Increase in hypodensity was compared with that in hyperdensity.
Fourteen patients showed enlargement of the hemorrhage. In all cases but one, the interval between injury and admission was 3 hours or less. Other factors had no statistical significance as predisposing causes for such enlargement. In approximately half of the cases, the hypodense component increased in the first 36 hours and continued increasing until the end of the first week. Evolution of the hypodense component was not dependent on behavior of the hemorrhage, surgical drainage, or diameter of the hemorrhagic lesion.
The natural evolution of the hyperdense component of temporal lobe lesions was to enlarge within the first few hours after the injury. Edema and necrosis developed more slowly and with no significant clinical manifestations.

6 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: The frontal and temporal lobe regions of the brain have a high vulnerability to injury as a consequence of cerebral trauma. One reason for this selective vulnerability is how the frontal and temporal regions are situated in the anterior and cranial fossa of the skull. These concavities of the skull base cup the frontal and temporal lobes which create surface areas of contact between the dura, brain, and skull where mechanical deformation injures the brain. In particular, the sphenoid ridge and the free-edge of the tentorium cerebelli are uniquely situated to facilitate injury to the posterior base of the frontal lobe and the anterior pole and medial surface area of the temporal lobe. Three-dimensional image reconstruction with computerized tomography and magnetic resonance imaging are used to demonstrate the vulnerability of these regions. How neuropsychological deficits result from damage to these areas is reviewed and discussed.
    Neuropsychology 10/2007; 21(5):515-31. DOI:10.1037/0894-4105.21.5.515 · 3.27 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Diagnosis and management of traumatic brain injury (TBI) is crucial to improve patient outcomes. While initial head computed tomography (CT) scan is the optimum tool for quick and accurate detection of intracranial hemorrhage, the guidelines on use of repeat CT differ among institutions. Three systematic reviews have been conducted on a similar topic; none have performed a comprehensive meta-analysis of all studies. Search of Medline, Cochrane, and a hand search of conference abstracts and references for all completed studies reporting data on change in management following repeat CT was conducted. Two authors reviewed all studies and extracted data using a standardized form. A proportional meta-analysis was conducted using random-effects model for outcomes related to any change in management following repeat CT. Any change in management included intracranial intervention, change in intracranial pressure monitoring, and/or administration of drug therapy. Search results yielded 6,982 references. In all, 41 studies enrolling 10,501 patients were included. Change in management following repeat CT was reported in 13 prospective and 28 retrospective studies and yielded a pooled proportion of 11.4% (95% confidence interval [CI] 5.9-18.4) and 9.6% (95% CI 6.5-13.2), respectively. In a subgroup analysis of mild TBI patients (Glasgow coma scale score 13 to 15), 5 prospective and 9 retrospective studies reported on change in management following repeat CT with the pooled proportion across prospective studies at 2.3% (95% CI 0.3-6.3) and across retrospective studies at 3.9% (95% CI 2.3-5.7), respectively. The evidence suggests that repeat CT in patients with TBI results in any change in management for a minority of patients. Better designed studies are needed to address the issue of the value of repeat CT in the management of TBI.
    Journal of neurotrauma 08/2013; 31(1). DOI:10.1089/neu.2013.2873 · 3.71 Impact Factor

Similar Publications