This paper reports an analysis of a series of primary brainstem injury resulted from blunt head trauma. The records of 25 patients with the diagnosis of primary brainstem injury, with decerebration, disturbed consciousness, typical manifestations of brainstem damage with no intracranial hematomas or other severe complications were studied retrospectively.
Our purpose is to define some of the factors affecting the prognosis of these patients. The particular factors we have evaluated are the age, the duration of decerebration, recovery time from the disturbed consciousness, other neurological findings and vital signs.
Their age varied from 3 to 67 years. Many cases in this series had a blow to the frontal or occipital region as a site of cranial impact. Skull fractures were found in 14 cases (56%). The mortality in this series was 56% (14 cases), 12 cases of which died within 7 days after the trauma.
Survived cases were classified by the residual deficits as minimal (2 cases), marked (4 cases) and prolonged coma (5 cases). Since the two cases with minimal deficits were children, it seems that the age of the patients is the most important factors for the prognosis.
The average duration of decerebration in the survived cases was 21 days in the cases with marked deficits and 14 days in the cases with minimal one. The duration less than 7 days of decerebrate state was a better prognostic sign than that more than 14 days.
Variable levels in the state of consciousness with fluctuations were found in this series. In the cases with marked deficits, mean recovery time was 77 days, whereas in those with minimal ones it was 42 days. It seems the shorter the period of the recovery, the better the prognosis.
Variable degrees of pyramidal signs, ocular symptoms or abnormalities in vital signs were seen. The mortality rate was high in the cases with bilateral pyramidal signs, dilated pupils without light reaction, anisocoria and marked fluctuations of vital signs.
These seem to be a poor prognostic signs.
There was no correlation between the pressure and appearance of cerebrospinal fluid and the quality of survivors.
The use of parenteral corticosteroids and tracheostomy were not related to the improvement of the prognosis.
It is concluded that the age was one of the most important factors affecting the prognosis of primary brainstem injury, and that the mortality and morbidity were clearly influenced by the duration of decerebration and recovery time from the state of vital signs.