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Imaging of Traumatic Brain Injury Imaging of Traumatic Brain Injury Yoshimi Anzai, MD, MPH Professor of Radiology Director of Neuroradiology Director of Head and Neck Imaging Co-Director of the Radiology Health Service Research Section Department of Radiology University of Washington Seattle, Washington Kathleen R. Fink, MD Assistant Professor of Neuroradiology Department of Radiology Harborview Medical Center University of Washington Seattle, Washington Thieme New York " Stuttgart " Delhi " Rio de Janiero Thieme Medical Publishers, Inc. Important note:Medicine is an ever-changing science undergoing 333 Seventh Ave. continual development. Research and clinical experience are con­ New York, NY 10001 tinually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy. Insofar as this book mentions Executive Editor: William Lamsback any dosage or application, readers may rest assured that the Managing Editor: J. Owen Zurhellen IV authors, editors, and publishers have made every effort to ensure Assistant Managing Editor: Heather Allen that such references are in accordance thewith state of knowledge Senior Vice President, Editorial and Electronic Product Development: at the time of production of the book. Cornelia Schulze Nevertheless, this does not involve, imply, or express any guar­ Production Editor: Sean Woznicki antee or responsibility on the part of the publishers in respect to any International Production Director: Andreas Schabert dosage instructions and forms of applications stated in the book. International Marketing Director: Fiona Henderson Every user is requested to examine thecarefully manufacturers ’ Director of Sales, North America: Mike Roseman leaflets accompanying each drug and to check, if necessary in con­ International Sales Director: Louisa Turrell sultation with a physician or specialist, whether the dosage sche­ Vice President, Finance and Accounts: Sarah Vanderbilt dules mentioned therein or the contraindications stated by the President: Brian D. Scanlan manufacturers differ from the statements made in the present book. Printer: Asia Pacic fiOffset, Inc. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Every dosage Library of Congress Cataloging-in-Publication Data schedule or every form of application used is entirelys at the user’ Imaging of traumatic brain injury / [edited by] Yoshimi Anzai,own risk and responsibility. The authors and publishers request Kathleen R Fink. every user to report to the publishers any discrepancies or inaccu­ p. ; cm. racies noticed. If errors in this work are found after publication, errata Includes bibliographic references will be posted at www.thieme.com on the product description page. ISBN 978-1-60406-728-6 (hardback)– ISBN 978-1-60406-729-3 Some of the product names, patents, and registered designs (eISBN) referred to in this book are in fact registered trademarks or propri­ I. Anzai, Yoshimi, editor. II. Fink, Kathleen R., editor. etary names even though specic referencefi to this fact is not always [DNLM: 1. Brain Injuries–diagnosis. 2. Brain Injuries–physiopa- made in the text. Therefore, the appearance of a name without thology. 3. Neuroimaging–methods. 4. Prognosis. WL 354] designation as proprietary is not to be construed as a representation RC387.5 by the publisher that it is in the public domain. 617.4'81044–dc23 2014014207 Copyright © 2015 by Thieme Medical Publishers, Inc. Thieme Publishers New York 333 Seventh Avenue, New York, NY 10001 USA +1 800 782 3488, [email protected] Thieme Publishers Stuttgart Rüdigerstrasse 14, 70469 Stuttgart, Germany +49 [0]711 8931 421, [email protected] Thieme Publishers Delhi A-12, Second Floor, Sector-2, Noida-201301 Uttar Pradesh, India +91 120 45 566 00, [email protected] Thieme Publishers Rio, Thieme Publicações Ltda. Argentina Building 16thfl oor, Ala A, 228 Praia do Botafogo Rio de Janeiro 22250-040 Brazil +55 21 3736-3631 This book, including all parts thereof, is legally protected by copy­ Printed in China 5 4 3 2 1 right. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation without thes publisherconsent ’ is ISBN 978-1-60406-728-6 illegal and liable to prosecution. This applies in particular to photo­ stat reproduction, copying, mimeographing or duplication of any Also available as an e-book: kind, translating, preparation of microlms, fiand electronic data eISBN 978-1-60406-729-3 processing and storage. To all physicians and nurses serving for trauma patients at Harborview Medical Center, Seattle, Washington. To my husband Satoshi and our daughter Erika for their love and support, and to my mother Kotoko Anzai who always believes in me. Yoshimi Anzai To my husband James, for his unwavering love and support, and to my beloved daughters Lucille and Michelle. Kathleen R. Fink Contents Foreword ......................................................................ix Preface ........................................................................xi Acknowledgments............................................................... xiii Contributors ................................................................... xv Chapter 1: Epidemiology of Traumatic Brain Injuries in the United States..................... 1 Bahman S. Roudsari and Yoshimi Anzai Chapter 2: Evidence-Based Imaging and Prediction Rules: Who Should Get Imaging for Mild Traumatic Brain Injury? ................................................. 7 Mahmud Mossa-Basha Chapter 3: Neuroimaging of Traumatic Brain Injury.................................... 12 Yoshimi Anzai Chapter 4: Pathophysiology of Traumatic Brain Injury and Impact on Management............ 35 Kathleen R. Fink Chapter 5: Pediatric Head Trauma................................................. 47 Jonathan O. Swanson and Jeffrey P. Otjen Chapter 6: Postoperative Imaging of Traumatic Brain Injury.............................. 57 Nicholas D. Krause, Kathleen R. Fink, and Yoshimi Anzai Chapter 7: Blunt Cerebrovascular Injury............................................. 70 Carrie P. Marder and Kathleen R. Fink Chapter 8: Penetrating Traumatic Brain Injury........................................ 81 Robert Linville and Wendy A. Cohen Chapter 9: Skull-Base Trauma.................................................... 90 Shivani Gupta and Kathleen R. Fink Chapter 10: Maxillofacial Trauma.................................................. 112 Jayson L. Benjert, Kathleen R. Fink, and Yoshimi Anzai Chapter 11: Traumatic Orbital and Occular Injury..................................... 126 Roberta W. Dalley and Sarah J. Foster Chapter 12: Advanced Imaging in Mild Traumatic Brain Injury and Concussion................ 159 Jalal B. Andre Index ....................................................................... 180 vii Foreword Traumatic brain injury is a leading cause of deathEpidemiology and dis­ and decision rules are discussed in separate ability in the United States. The mortality and cmorbidityhapters. The special considerations of pediatric head trauma associated with traumatic brain injury have declined.are explored. Outside the brain, but vital to the comprehen­ Improved patient outcomes have resulted from improve­sive care of the brain injured patient, are chapters detailing ments in emergency department diagnosis which leadscerebrovascular to injuries, skull base injuries, maxillofacial effective emergent treatment. CT is usually the initialinjuries, imag­ and orbital injuries. It is appropriate that the book ing study performed on a patient with traumatic brain concludesinjury. with a chapter about advanced imaging. Magnetic Medical imaging helps tofine dethe acute injury and,resonance if techniques including diffusion tensor imaging, necessary, to guide acute surgical intervention. It spectroscopy,has also susceptibility imaging, and functional imaging contributed to our understanding of the nature andare patho­illustrated. There are also brief discussions of magneto­ physiology of these injuries. encephalography and positron emission tomography. These Overall, the use of CT in the emergency departmentadvanced techniques have deepened our understanding of increased more than threefold between 1996 and 2007;traumatic brain injury in selected patient cohorts. This chap­ however when adjustments are made for variables tersuch may as serve as a preview to the next clinically relevant new severity of injury there may be little change in the utilizationimaging techniques to be applied to the care of traumatic rate of cranial CT. Increased CTusage has likely resultedbrain frominjuries. the increased 24 hour availability of CT in emergency depart­This book provides the radiologist with an important ments. Along with the increased use of emergentresour CT, ce hasfor the interpretation of images of the brain, face, come a greater emphasis on accurate and rapid andimaging neck of the brain injured patient. To the clinician caring interpretation. The role of the radiologist has becomefor muchthe brain injured patient, it provides helpful guidelines for more central to the health care delivery team. Radiologiststhe ordering of imaging studies and insight into how the who may not be specialty trained in emergency imagingpathophysiology or in of injury is depicted by imaging. Those neuroimaging are being increasingly called upon to provideresearchers a studying traumatic brain injury will gain a better high level of contemporaneous imaging interpretation.understanding The of how
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