THE PERSISTENT VEGETATIVE STATE AFTER CLOSED-HEAD INJURY - CLINICAL AND MAGNETIC-RESONANCE-IMAGING FINDINGS IN 42 PATIENTS

Object. In this retrospective study, the authors analyzed the frequenc y, anatomical distribution, and appearance of traumatic brain lesions in 42 patients in a posttraumatic persistent vegetative state. Methods . Cerebral magnetic resonance (MR) imaging was used to detect the numb er of lesions, which ranged from as few as five to as many as 19. with a mean of 11 lesions. In all 42 cases there was evidence on MR imagin g of diffuse axonal injury, and injury to the corpus callosum was dete cted in all patients. The second most common area of diffuse axonal in jury involved the dorsolateral aspect of the rostral brainstem (74% of patients). In addition, 65% of these patients exhibited white matter injury in the corona radiata and the frontal and temporal lobes. Lesio ns to the basal ganglia or thalamus were seen in 52% and 40% of patien ts, respectively, Magnetic resonance imaging showed some evidence of c ortical contusion in 48% of patients in this study: the frontal and te mporal lobes were most frequently involved. Injury to the parahippocam pal gyrus was detected in 45% of patients; in this subgroup there was an 80% incidence of contralateral peduncular lesions in the midbrain. The most common pattern of injury (74% in this series) was the combina tion of focal lesions of the corpus callosum and the dorsolateral brai nstem. In patients with no evidence of diffuse axonal injury in the up per brainstem (26% in this series), callosal lesions were most often a ssociated with basal ganglia lesions. Lesions of the corona radiata an d lobar white matter were equally distributed in patients with or with out dorsolateral brainstem injury. Moreover, cortical contusions and t halamic, parahippocampal, and cerebral peduncular lesions were also si milarly distributed in both groups. Conclusions. The: data indicate th at diffuse axonal injury may be the major form of primary brain damage in the posttraumatic persistent vegetative state. In addition, the au thors demonstrated in this study that MR imaging, in conjunction with a precise clinical correlation, may provide useful supportive informat ion for the accurate diagnosis of a persistent vegetative state after traumatic brain injury.