Immediate coma following inertial brain injury dependent on axonal damage in the brainstem

Object. immediate and prolonged coma following brain trauma has been shown to result from diffuse axonal injury (DAI). However, the relationship betwe en the distribution of axonal damage and posttraumatic coma has not been ex amined. In the present study, the authors examine that relationship. Methods. To explore potential anatomical origins of posttraumatic coma, the authors used a model of inertial brain injury in the pig. Anesthetized min iature swine were subjected to a nonimpact-induced head rotational accelera tion along either the coronal or axial plane (six pigs in each group). Imme diate prolonged coma was consistently produced by head axial plane rotation , but not by head coronal plane rotation. Immunohistochemical examination o f the injured brains revealed that DAI was produced by head rotation along both planes in all animals. However, extensive axonal damage in the brainst em was found in the pigs injured via head axial plane rotation. In these an imals, the severity of coma was found to correlate with both the extent of axonal damage in the brainstem (p < 0.01) and the applied kinetic loading c onditions (p < 0.001). No relationship was found between coma and the exten t of axonal damage in other brain regions. Conclusions. These results suggest that injury to axons in the brainstem pl ays a major role in induction of immediate posttraumatic coma and that DAI can occur without coma.