Severe leukoaraiosis portends a poor outcome after traumatic brain injury
Department of Neurology
Age Factors; Aged; Aged, 80 and over; Brain Injuries; Cohort Studies; Female; Glasgow Coma Scale; *Glasgow Outcome Scale; Humans; Leukoaraiosis; Male; Middle Aged; Prognosis; Retrospective Studies; Severity of Illness Index; Tomography, X-Ray Computed; White Matter
Nervous System Diseases | Neurology
BACKGROUND AND PURPOSE: It is now well accepted that traumatic white matter injury constitutes a critical determinant of post-traumatic functional impairment. However, the contribution of preexisting white matter rarefaction on outcome following traumatic brain injury (TBI) is unknown. Hence, we sought to determine whether the burden of preexisting leukoaraiosis of presumed ischemic origin is independently associated with outcome after TBI.
METHODS: We retrospectively analyzed consecutive, prospectively enrolled patients of > /=50 years (n = 136) who were admitted to a single neurological/trauma intensive care unit. Supratentorial white matter hypoattenuation on head CT was graded on a 5-point scale (range 0-4) reflecting increasing severity of leukoaraiosis. Outcome was ascertained according to the modified Rankin Scale (mRS) and Glasgow outcome scale (GOS) at 3 and 12 months, respectively.
RESULTS: After adjustment for other factors, leukoaraiosis severity was significantly associated with a poor outcome at 3 and 12 months defined as mRS 3-6 and GOS 1-3, respectively. The independent association between leukoaraiosis and poor outcome remained when the analysis was restricted to patients who survived up to 3 months, had moderate-to-severe TBI [enrollment Glasgow Coma Scale (GCS) < /=12; p = 0.001], or had mild TBI (GCS 13-15; p = 0.002), respectively.
CONCLUSION: We provide first evidence that preexisting cerebral small vessel disease independently predicts a poor functional outcome after closed head TBI. This association is independent of other established outcome predictors such as age, comorbid state as well as intensive care unit complications and interventions. This knowledge may help improve prognostic accuracy, clinical management, and resource utilization.
DOI of Published Version
Neurocrit Care. 2014 Dec;21(3):483-95. doi: 10.1007/s12028-014-9980-0. Link to article on publisher's site
Henninger N, Izzy S, Carandang RA, Hall WR, Muehlschlegel S. (2014). Severe leukoaraiosis portends a poor outcome after traumatic brain injury. Neurology Publications. https://doi.org/10.1007/s12028-014-9980-0. Retrieved from https://escholarship.umassmed.edu/neuro_pp/433