Traumatic brain and Brachial plexus injuries: An observational study of the epidemiology and analysis of factors affecting the outcome. Jean-Marie Louppe (M.D., M.Sc.), Judith Marcoux (M.D., M.Sc., FRCS(C)), Line Jacques (M.D., M.Sc., FRCS(C), DABNS) Department of neurosurgery, Montreal Neurological Hospital and Institute, McGill university, Qc Canada Department of neurotraumatology, Montreal General Hospital, McGill university, Qc Canada

Introduction Results epidemiological datas of the 3 groups. operative results in relation to the Among factors affecting the outcome • description of the population is intensity of head trauma in brachial plexus injuries, delay to summerized in the table 1. In the referral and surgery, cerebral head trauma population, most plasticity, as well as cognitive frequent neuropsychological possibilities in the rehabilitation stage issues involved memory (76%), are of utmost importance. These attention (56%), executive factors can be modified by a functions (35%), global efficiency simultaneous brain injury, but few (29%) and psychoaffective aspect reports have focused on this specific (29%). Glasgow Outcome Scale issue. was favorable in all but one brachial plexus surgery yields worse patient. Most frequent brain results in population of concomitant mild Methods imaging were subarachnoid and severe head trauma than in the rest of We retrospectively reviewed both our hemorrage and subdural the population. (p=0,0201) traumatic brain injury and brachial hematomas. Time from trauma to plexus (departement of neurosurgery) referral and surgery were shorter Conclusions databases, over a 12-year period in case of head trauma. Lesions of Presence of a concomittant brain injury (2000- 2011). We identified 97 better prognosis were more may adversely affect the motor patients who where followed for a this table shows differences between the 3 frequent in the first group (less outcome of the upper limb. Time to brachial plexus injury, distributed as groups. In particular flail arms are more whole plexus involvment, more referral and time to surgery are similar follows : no concomittent head trauma frequent in case of concomittent head lacerations and gun-shot- in the populations, but differences in (46 patients), concomittent mild head trauma. wounds). Incidence of associated severity of the initial brachial plexus trauma (21 patients), moderate to fracture and vascular injury, as lesion could expain this phenomenon. overall outcome in relation to severe head trauma (28 patients). markers of trauma velocity were concomitant head trauma Criterias used for mild head trauma similar in the 3 groups. References were GCS 13-15, or loss of Respectively 18% and 14% of -Ahmed-Labib, M., J.D. Golan, and L. Jacques, Functional outcome of brachial plexus consciousness. Criterias for moderate- patients with a concomitent head reconstruction after trauma. Neurosurgery, trauma were never referred to the to-critical head trauma were GCS<13 2007. 61(5): p. 1016-22; discussion 1022-3. or pahological findings in brain brachial plexus team. -Midha, R., Epidemiology of brachial plexus imaging. Most of the final neurologic • Comparison of the motor outcome injuries in a multitrauma population. Neurosurgery, 1997. 40(6): p. 1182-8; exams were done by an independant of the operated population discussion 1188-9. showed a significant bad examiner. Statistical test used were -Alnot, J.Y. and A. Narakas, Traumatic Brachial Kruskal-Wallis H-test and chi square prognosis in case of head trauma Plexus Injuries. 1996: Expansion scientifique regardless of the brachial plexus strategy test. (figure 1, p=0,0201). Comparing française. (surgery or observation), outcomes are the global population (both -Schmidt, R.A. and T.D. Lee, Motor control and learning : a behavioral emphasis. 5th ed, worse in case of associated head trauma patients operated and followed) Champaign, IL: Human Kinetics. ix, 581 p. showed the same result (figure 1,

p<0,0001).