J Bonnal

Relative prognostic value of best motor response and brain stem reflexes in patients with severe head injury.

The object of this study was to determine whether the addition of information on brain stem reflexes improves the prognostic precision of the Glasgow coma scale for patients with severe head trauma. The study is based on 109 patients with a Glasgow coma score of 7 or less during the first 24 hours after injury. The average age was 23 years. The patients were classified into three groups according to their actual outcome after 6 months: dead, 44 patients; persistent vegetative state and severe disability, 13 patients; moderate disability and good recovery, 52 patients. We then compared, by means of multiple group logistic regression, the prognostic ability of motor responses alone using the Glasgow criteria and of brain stem reflexes via an original approach. We showed that the predictive capabilities of brain stem reflexes were greater than those of motor responses. Although closely related (r = 0.68), the use of these two parameters in a single scale, the Glasgow-Liege scale, improves the precision of prognosis, especially for those head trauma patients with initial and complete loss of consciousness. Age was also revealed to be an important factor for outcome prediction.

Clinical and radiological aspects of dysplastic gangliocytoma (Lhermitte-Duclos disease): a report of two cases with review of the literature.

Two cases of Lhermitte-Duclos disease confirmed by biopsy are reported. Review of the 58 published cases shows that the disease can manifest itself only by signs of increased intracranial pressure. Cerebellar symptoms are not constant. Computed tomographic (CT) scans suggest the diagnosis by showing a posterior fossa lesion, iso- and hypodense, partially calcified, and not enhanced by contrast medium. Magnetic resonance imaging (MRI) seems to define limits of the lesion better than CT scanning and could improve the surgical approach. Surgical excision of the lesion is the only satisfactory treatment. The postoperative prognosis is usually favorable.

Interobserver agreement in assessment of motor response and brain stem reflexes.

In 1982, we developed a new coma scale, the Glasgow-Liège scale, which combines the quantified analysis of five brain stem reflexes with the Glasgow methodology. The present study was undertaken to determine to what extent agreement exists among different raters assessing brain stem reflexes (Parameter R) and to compare the results with those observed from motor responses (Parameter M). We show the good agreement achieved by different examiners in the evaluation of brain stem reflexes. Brain stem reflexes offer a slightly higher agreement (kappa = 0.69) than that of the study of motor response (kappa = 0.65). Within Parameters M and R, we observed less agreement in the evaluation of flexion responses and in the interpretation of oculocephalic reactions. The reliability of the evaluation of M and R parameters justifies the use of the Glasgow-Liège scale as a means for evaluating disturbances of consciousness.