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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n y Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La TAC craneal permite la evaluaci&#243;n quir&#250;rgica urgente de un TCE&#44; pero no supone una evaluaci&#243;n completa de las lesiones encef&#225;licas producidas&#46; La resonancia magn&#233;tica &#40;RM&#41; puede complementar la evaluaci&#243;n del TCE&#44; especialmente a nivel de tronco cerebral&#46; Utilizando la secuencia FLAIR pretendemos obtener una estimaci&#243;n de la frecuencia de lesi&#243;n primaria traum&#225;tica de tronco cerebral&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se presenta una serie prospectiva de 30 casos con TCE moderado o grave &#40;GCS&#8804;13&#41; a los que se les realiz&#243; RM en un intervalo menor a dos semanas tras el traumatismo&#46; En la serie se incluyeron exclusivamente pacientes j&#243;venes &#40;entre 16 y 40 a&#241;os&#41;&#44; con objeto de excluir lesiones previas de tipo isqu&#233;mico no relacionadas con el traumatismo&#46; Quedaron fuera los pacientes con cirug&#237;a craneal para excluir lesiones yatrog&#233;nicas&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En base a estudios previos&#44; se utiliz&#243; la secuencia FLAIR &#40;Fluid Attenuated Inversi&#243;n Recovery 8000&#47; 120&#47; T&#46; Inversi&#243;n 2200mseg&#41; para la detecci&#243;n &#243;ptima de lesiones de tronco cerebral&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En un 26&#44;6&#37; de los casos se apreciaron lesiones en tronco cerebral confirmadas por dos radi&#243;logos independientes&#46; De ellas&#44; seis casos correspond&#237;an a lesiones hiperintensas compatibles con lesi&#243;n axonal difusa y dos casos a lesi&#243;n hemorr&#225;gica&#46; La supervivencia de la serie fue del 100&#37;&#44; si bien este dato est&#225; sesgado por la selecci&#243;n exclusiva de pacientes que en un plazo inferior a dos semanas hab&#237;an salido de cuidados intensivos&#46; En cuatro casos pudo establecerse una relaci&#243;n directa entre lesi&#243;n y focalidad neurol&#243;gica&#46; En el resto&#44; la lesi&#243;n fue relacionada con trastornos inespec&#237;ficos del nivel de consciencia&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Consideramos que la RM en secuencia FLAIR nos permite visualizar un tipo de lesi&#243;n traum&#225;tica de tronco cerebral &#40;posiblemente lesi&#243;n axonal&#41; que presenta mayor frecuencia y menor gravedad pronostica que aquellas otras descritas cl&#225;sicamente en estudios realizados mediante TAC&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction and Objectives</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">CT-scan allows emer-gency surgical evaluation of head injury lesions&#44; but does not offer a comprehensive diagnosis of the resulting brain injuries&#46; Magnetic Resonance Imaging &#40;MRI&#41; can complete the evaluation of head injury&#44; par-ticularly in the brain stem&#46; We attempted to est&#237;mate the frequency of traumatic primary brain stem injuries by using the FLAIR &#40;Fluid Attenuated Inversi&#243;n Recovery&#41; sequence&#46;</p> <span class="elsevierStyleSectionTitle">Material and Methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Thirty patients with mod&#233;rate or severe head injury &#40;GCS&#8804;13&#41; underwent a MRI study during the first two weeks after trauma&#46; In order to exelude o&#237;d patients with previous ischemic lesions unrelated to the head trauma&#44; only young patients &#40;16&#8211;40 years-old&#41; were included&#46; Patients with cranial surgery were also eliminated from the study&#46; Based on previous studies&#44; the FLAIR &#40;8000&#47;120&#47;T&#46; Inversi&#243;n 2200mseg&#41; sequence was selected&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Brain stem injuries were detected in 26&#46;6&#37; of the patients&#59; this was confirmed by two independent radiologists&#46; Six patients had hyperintense lesions compatible with diffuse axonal damage&#44; and two others showed hemorrhagic lesions&#46; These flndings were directly related to a specific neurological d&#233;ficit in four patients&#59; while in the remaining&#44; unspecific conscious-ness disturbances were noted&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">We believe that the FLAIR sequence dem&#243;nstrate a type of traumatic brain stem injury &#40;probably corresponding to diffuse axonal injury&#41; that is more frequent and less severe in terms of prognosis than those classically described in previous CT sean studies&#46;</p>"
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Lesión traumática del tronco cerebral diagnosticada por resonancia magnética. Reconsideración epidemiológica y pronostica
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R. Begué*, J. Diez*
* Instituí de diagnostic per l’imatge. Hospital Universitari Arnau de Vilanova. Lleida

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