{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T20:04:04Z","timestamp":1772309044499,"version":"3.50.1"},"reference-count":27,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>The objective of this study was to test the hypothesis that midline (interhemispheric or perimesencephalic) traumatic subarachnoid hemorrhage (tSAH) on initial CT may implicate the same shearing mechanism that underlies severe diffuse axonal injury (DAI).<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The authors enrolled 270 consecutive patients (mean age [\u00b1 SD] 43 \u00b1 23.3 years) with a history of head trauma who had undergone initial CT within 24 hours and brain MRI within 30 days. Six initial CT findings, including intraventricular hemorrhage (IVH) and tSAH, were used as candidate predictors of DAI. The presence of tSAH was determined at the cerebral convexities, sylvian fissures, sylvian vallecula, cerebellar folia, interhemispheric fissure, and perimesencephalic cisterns. Following MRI, patients were divided into negative and positive DAI groups, and were assigned to a DAI stage: 1) stage 0, negative DAI; 2) stage 1, DAI in lobar white matter or cerebellum; 3) stage 2, DAI involving the corpus callosum; and 4) stage 3, DAI involving the brainstem. Glasgow Outcome Scale\u2013Extended (GOSE) scores were obtained in 232 patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Of 270 patients, 77 (28.5%) had DAI; tSAH and IVH were independently associated with DAI (p &lt; 0.05). Of tSAH locations, midline tSAH was independently associated with both overall DAI and DAI stage 2 or 3 (severe DAI; p &lt; 0.05). The midline tSAH on initial CT had sensitivity of 60.8%, specificity of 81.7%, and positive and negative predictive values of 43.7% and 89.9%, respectively, for severe DAI. When adjusted for admission Glasgow Coma Score, the midline tSAH independently predicted poor GOSE score at both hospital discharge and after 6 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Midline tSAH could implicate the same shearing mechanism that underlies severe DAI, for which midline tSAH on initial CT is a probable surrogate.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2017.6.jns17466","type":"journal-article","created":{"date-parts":[[2018,1,5]],"date-time":"2018-01-05T14:59:43Z","timestamp":1515164383000},"page":"1317-1324","source":"Crossref","is-referenced-by-count":36,"title":["Traumatic midline subarachnoid hemorrhage on initial computed tomography as a marker of severe diffuse axonal injury"],"prefix":"10.3171","volume":"129","author":[{"given":"Daddy","family":"Mata-Mbemba","sequence":"first","affiliation":[{"name":"Departments of Diagnostic Radiology,"},{"name":"Neurosurgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shunji","family":"Mugikura","sequence":"additional","affiliation":[{"name":"Departments of Diagnostic Radiology,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsuhiro","family":"Nakagawa","sequence":"additional","affiliation":[{"name":"Neurosurgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takaki","family":"Murata","sequence":"additional","affiliation":[{"name":"Departments of Diagnostic Radiology,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiyoshi","family":"Ishii","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sendai Kousei Hospital, Sendai, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shigeki","family":"Kushimoto","sequence":"additional","affiliation":[{"name":"Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teiji","family":"Tominaga","sequence":"additional","affiliation":[{"name":"Neurosurgery, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shoki","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Departments of Diagnostic Radiology,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kei","family":"Takase","sequence":"additional","affiliation":[{"name":"Departments of Diagnostic Radiology,"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Histopathology","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1111\/j.1365-2559.1989.tb03040.x","article-title":"Diffuse axonal injury in head injury: definition, diagnosis and grading","volume":"15","author":"Adams JH","year":"1989","unstructured":"Adams JH, Doyle D, Ford I, Gennarelli TA, Graham DI, McLellan DR: Diffuse axonal injury in head injury: definition, diagnosis and grading. 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