Post-traumatic brain stem distortion: A case report

BACKGROUND Primary traumatic brain stem injury (BSI) lesions are found most frequently in the dorsal or dorsolateral midbrain, whereas distortion of the brain stem itself is exceedingly rare. CASE REPORT We present a 20-year-old woman with a rare brain stem injury caused by a violent motor vehicle collision. Magnetic resonance imaging at 2 months after injury revealed marked brain stem distortion with loss of the normal shape at the midbrain and pens, which were displaced anteriorly in association with the fracture of the clivus. Moreover, the medulla oblongata showed a loose winding configuration. At discharge about 5 months after injury, the Glasgow Outcome Scale was severe disability. CONCLUSION This BSI was caused by reciprocal actions of fracture of the clivus and the direct effect on the brain stem caused by acceleration or rotational forces. (C) 1999 by Elsevier Science inc.