Clinical outcome after head injury in children

For at least 1 year we have done a follow-up on 178 children under the age of 18 years with head injuries treated between 1981 and 1987. The Brussel Coma Scale and the Glasgow Outcome Score were used to determine neurological deficits and patient outcome. In children with coma, there was good recovery or moderate disability in 71.4%, severe disability in 6.1%, and death in 22.5%. When all head injuries were taken into consideration, a satisfactory outcome was found in 84.3%, severe disability in 3.3%, and death in 12.4%. The outcome mainly depended on the initial coma grade, but the duration of coma or advanced age were also negative factors for outcome. In 14.8%, intracranial mass lesions showed no significant correlation with outcome. In contrast to adults, diffuse brain swelling had a satisfactory outcome in 85.1%.Presented at the 11th Meeting of the European Society for Paediatric Neurosurgery, Naples 1988     

Severe head injury in children: early prognosis and outcome

The outcome is reported in 62 children with severe head injuries following a road traffic accident. All patients were comatose for at least 6 h; all patients were graded using the Glasgow Coma Score (GCS) or the Children Coma Score (CCS). Fifty-four patients were comatose immediately after injury, 8 after a lucid interval. Thirty patients had isolated head injuries and 32 had associated injuries, either long bone fractures or rupture of an abdominal organ. Additional information concerning main brainstem reflexes, posture and respiration was included in the study. The overall mortality was 32%. The goal of the study was to identify those clinical features available soon after injury which are important indicators of treatment and outcome.Presented at the 11th Scientific Meeting of the International Society for Pediatric Neurosurgery, Gothenburg, 1983     

Early outcome prediction in severe head injury: comparison between children and adults

The prognostic value in 49 children and 56 adults of the following parameters recorded on admission was analyzed: oculocephalic and light reflexes, posturing, Glasgow Coma Scale (GCS), the need for ventilatory support, and the presence of associated injuries. All patients had been in coma for at least 6 h. The presence of intracranial hematoma and the duration of coma were recorded and the relative risk of poor outcome calculated. There was poor outcome in 51% of the children and 61% of the adults. Oculocephalic and light reflexes, posturing, GCS, need for ventilatory support, and duration of coma were significantly related to the outcome in children. Only oculocephalic and light reflexes, and posturing were significantly related to the outcome in adults. Some parameters appeared to have different prognostic value in children and in adults: the simultaneous evaluation of oculocephalic reflex and need for ventilation was the best prognostic guide in children, the light reflex was the best prognostic indicator in adults.     

Cerebellar atrophy after severe traumatic head injury in children

Object: The purpose of this study was to describe late neuropathological MRI findings in pediatric severe head injury and to explore the relationship between these lesions and cognitive sequelae. Methods: Thirteen infants with severe head trauma (Glasgow 6) were included in this investigation. Clinical examination, a battery of tests designed to assess neurophysiological status, and MRI investigations of the brain were obtained in periods ranging between 8 and 20 months after the accident. Hemosiderin deposits, encephalomalacia, and cerebellar atrophy were the most frequent traumatic sequelae. The lesions were located in frontal lobes, the basal ganglia, and the cerebellum. Six patients had cerebellar atrophy associated with frontal or temporal postraumatic lesions. Cerebellar clinical dysfunction was observed in only 3 of these patients. Performance on tests evaluating frontal lobe functions was depressed in 5 of them. Conclusions: Late MRI after severe head trauma in our pediatric population showed unexpected cerebellar atrophy. Its correlation with prefrontal dysfunction is difficult to confirm because of its association with other parenchymal post-traumatic lesions. Further research involving a larger sample of patients with brain injury of varying severity is in progress, to investigate whether cerebellar atrophy could be a consequence of severe head trauma. Received: 25 May 2000 Revised: 4 July 2000     

Prognostic implications of hyperglycaemia in paediatric head injury

Fifty children with head injury were evaluated in an attempt to estabilish a correlation between post-traumatic hyperglycaemia and long-term outcome. In all the patients, the blood glucose level was measured on admission and on the days following the trauma (threshold of normal value set at 150 mg/dl). Hyperglycaemia was seen more frequently in children with severe head injury than in those with mild and moderate head injury. It was present in 87.5% of the patients with a Glasgow Coma Score (GCS) ≤8 (the average blood glucose level on admission was 237.8±92 mg/dl), in 60% of the patients with a GCS of 9–12 (178±78.7 mg/dl) and only in 25% of those with a GCS of 13–15 (131.5±39 mg/dl). A close correlation was also seen between the outcome and the blood glucose level. In fact, the blood glucose on admission was higher in the patients with a poor outcome, i.e. in those having a Glasgow Outcome Score (GOS) of 2 or 3 and in those who died (GOS 1), than in the patients with a good outcome (GOS of 4 or 5). Finally, hyperglycaemia persisted beyond the first 24 h after trauma in all the children who died or who survived with a poor outcome. Hyperglycaemia, and especially its persistence over time, appears to be an important negative prognostic factor in children with head injury. Received: 14 May 1998     

颅内结核瘤的临床与MRI特点分析

目的为提高颅内结核瘤的诊断和治疗水平.方法10年来共收治32例颅内结核瘤患者,其中手术、立体定向活检术及尸检证实8例,抗结核治疗有效24例,全部病例均行头颅MRI扫描.结果32例脑结核瘤MRI显示单发25例,多发7例,共发现46个病灶,不同类型的结核瘤MRI表现各异,不同类型结核瘤对抗结核药物的反应不同.结论MRI可以明确诊断典型的脑结核瘤,并能帮助提高鉴别诊断水平.     

外伤性胼胝体损伤的MRI诊断

[目的] 观察颅脑创伤致胼胝体损伤的MRI表现,为临床提供有价值的诊断信息,提高颅脑创伤的救治水平. 方法 回顾分析临沂市人民医院神经外科自2007年至2009年收治疗的20例MRI证实为胼胝体损伤患者的临床、影像资料,观察其临床表现及MRI各序列特征. 结果 外伤性胼胝体损伤在临床较为少见,以非出血性损伤为主,损伤部位常见于体部及压部,少数位于膝部,嘴部损伤罕见.对于早期非出血性损伤,MRI常表现为稍长T1稍长T2信号,且常伴弥漫性轴索损伤的表现.在胼胝体损伤的中后期,胼胝体局部往往萎缩,病灶区易出现液化坏死,可有胶质瘢痕及软化灶形成,在MR/表现为长T1长T2信号,且信号强度近似于脑脊液,还可见相应部位的脑室扩大.在弥散加权成像(DWI)可见非出血性损伤在急性期和亚急性期呈高信号,随着时间延长,信号逐渐减低至正常脑组织信号,如形成软化灶,则表现为脑脊液信号. 结论 外伤性胼胝体损伤可引起严重后果,在重型颅脑损伤中并不罕见,应当引起临床医生重视.MRI是显示胼胝体损伤病灶最好的影像学检查手段,不仅对其微小病变敏感显示,且能够多方位地显示病变.     

磁共振成像在脑干损伤中的诊断价值

目的 比较MR、CT和体格检查在脑干损伤早期诊断中的作用.方法 将颅脑损伤后出现意识障碍需排除脑干损伤的21例患者在保持气道通畅等情况下,进行体格检查、CT和MR检查,并对诊断结果进行对比分析.结果 本组21例颅脑损伤后意识昏迷患者中出现脑干损伤症状17例,行气管切开14例,行颅内血肿或脑挫伤减压手术7例.21例均行头颅CT检查示脑干区低密度影9例,广泛性蛛网膜下腔出血或环池周围出血7例,轻度蛛网膜下腔出血表现或脑干周围变化不明显5例;头颅MRI检查证实脑干损伤15例,另6例仅为纵裂、颅底、半球区脑挫伤.结论 MRI对于脑干损伤的诊断优于CT及体格检查,可起到确诊作用.     

Vomiting in children following head injury

The criteria for hospital admission of children who have suffered a minor head injury are highly subjective. Often the presence of post-traumatic emesis becomes an influential factor, but the mechanisms that trigger emesis following minor head injuries are not known. From a prospective study of 96 consecutive children with their first mild head injury (GCS 13–15) and a retrospective study of 29 consecutive more seriously injured children (GCS 8–12), we conclude that post-traumatic emesis is more common: (1) following minor head injuries than following more severe head injuries (P<0.05); (2) in children over 2 years old; (P<0.001); (3) in children injured within an hour of a meal or snack (p<0.001). The presence of a skull fracture or the site of the impact does not influence the incidence or duration of post-traumatic emesis. Retching and vomiting generally subside within 3 h in children injured within an hour of a meal or snack. When vomiting appears in children injured more than an hour after a meal or a snack, it may be quite protracted (mean=7.5 h). Children over 2 years of age with post-traumatic emesis who are neurologically stable following a mild head injury that occurred within an hour of a meal or snack can be expected to improve quickly. Their counterparts injured more than an hour after a meal or snack are likely to remain distressed much longer and are best admitted to hospital.     

Localized in vivo H-MRS of traumatic brain injury

¹H-MRS examinations were carried out on 14 patients, recovering from traumatic brain injury (TBI), who were in a stabilized clinical status and showed a good clinical outcome. Magnetic resonance spectra were recorded in subcortical (SC) and mid-brain (MB) areas where no detectable lesions appeared under magnetic resonance imaging. These two brain areas were selected because they are crucial sites of damage due to the physiopathologic mechanisms of TBI. A significant increase in inositol and choline peaks was found in MB compared to a control group of healthy individuals, whereas lower N-acetyl-aspartate peaks in the same area were detected. Reduced levels in the latter metabolite were also evident in the SC area. A significant correlation emerged between the inositol concentration in MB and the Glasgow Coma Scale Score measured just after the trauma. No correlation was found between the Glasgow Outcome Scale (GOS) at the time of the ¹H-MRS examination and the peaks of all the metabolites. Our study demonstrated that ¹H-MRS is a sensitive tool to evidentiate brain metabolic damage after TBI even in areas with lesions that are not detectable with current imaging techniques. The present research also shows an association between the alteration in one of the brain metabolites and the clinical parameters of TBI severity, but does not provide a clinical index of the patient's recovery. Further longitudinal studies on more conspicuous groups of patients with TBI could help to clarify whether metabolite modifications revealed by ¹H-MRS could be predictive of clinical outcome.     

儿童与成人病毒性脑炎MRI表现的对比分析

目的探讨儿童与成人病毒性脑炎MRI表现的差异。方法回顾分析57例临床确诊为病毒性脑炎的MRI结果,比较儿童与成人的MRI表现。结果儿童病毒性脑炎常表现为对称性病灶,且更易累及丘脑、脑干,较少累及大脑半球。而成人病毒性脑炎更易累及大脑半球。结论儿童与成人病毒性脑炎的发病部位存在差异,MRI能提供重要的诊断信息。     

Immediate postoperative MRI findings after lumbar decompression surgery: Correlation of imaging features with clinical outcome

An understanding of the common MRI findings observed after decompression surgery is important. However, to date, no study addressing this has been published. The aim of this study was to analyze and describe the immediate postoperative MRI findings after lumbar decompression surgery. We retrospectively analyzed the immediate postoperative MRIs of 121 consecutive patients who underwent lumbar decompression surgery between July 2017 and June 2018. Changes in stenosis at the decompressed and adjacent levels, epidural fat edema, epidural and subdural fluid collections, nerve root swelling, facet joint effusions, intervertebral disc signal, and paravertebral muscle edema were correlated with clinical characteristics. Both groups had reduced central canal stenosis postoperatively (p < 0.001) but worsened stenosis at adjacent segments. Fluid collection, hemorrhagic or non-hemorrhagic, at the laminectomy site was the commonest finding (one-level: 73.8%, two-level: 88.5%), with a higher percentage of severe central canal compromise in the two-level decompression group (p = 0.003). Other postoperative MRI findings, such as epidural fat edema, nerve root swelling, subdural fluid collection, and facet joint effusion, were noted without statistical significance. In conclusion, even with successful decompression for lumbar canal stenosis, increased central canal stenosis at adjacent segments is common on immediate postoperative MRI scans, showing no statistically significant correlation with the immediate postoperative outcome. Postoperative fluid collection at the laminectomy site is the commonest imaging finding, and higher rates of hemorrhagic fluid and more severe central canal compromise occur in two-level decompression, but rarely cause clinical problems.     

Injury volume extracted from MRI predicts neurologic outcome in acute spinal cord injury: A prospective TRACK-SCI pilot study

Conventional MRI measures of traumatic spinal cord injury severity largely rely on 2-dimensional injury characteristics such as intramedullary lesion length and cord compression. Recent advances in spinal cord (SC) analysis have led to the development of a robust anatomic atlas incorporated into an open-source platform called the Spinal Cord Toolbox (SCT) that allows for quantitative volumetric injury analysis. In the current study, we evaluate the prognostic value of volumetric measures of spinal cord injury on MRI following registration of T2-weighted (T2w) images and segmented lesions from acute SCI patients with a standardized atlas. This IRB-approved prospective cohort study involved the image analysis of 60 blunt cervical SCI patients enrolled in the TRACK-SCI clinical research protocol. Axial T2w MRI data obtained within 24 h of injury were processed using the SCT. Briefly, SC MRIs were automatically segmented using the sct_deepseg_sc tool in the SCT and segmentations were manually corrected by a neuro-radiologist. Lesion volume data were used as predictor variables for correlation with lower extremity motor scores at discharge. Volumetric MRI measures of T2w signal abnormality comprising the SCI lesion accurately predict lower extremity motor scores at time of patient discharge. Similarly, MRI measures of injury volume significantly correlated with motor scores to a greater degree than conventional 2-D metrics of lesion size. The volume of total injury and of injured spinal cord motor regions on T2w MRI is significantly and independently associated with neurologic outcome at discharge after injury.     

高分辨核磁共振成像在预测儿童局灶性皮质发育不良手术效果中的价值

目的 探讨高分辨核磁共振成像(MRI)在儿童局灶性皮质发育不良(Focal cortical dysplasia,FCD)手术中的效果及价值.方法 回顾性分析2013年7月-2018年7月于山东大学齐鲁儿童医院经手术病理证实的143例FCD患儿的MRI及临床资料,年龄5月龄～12.5岁,既往无治疗史,分析其MRI征象:...     

Randomized placebo-controlled trial of mitoxantrone in relapsing-remitting multiple sclerosis: 24-month clinical and MRI outcome

We designed a randomized, placebo-controlled, multicentre trial involving 51 relapsing-remitting multiple sclerosis patients to determine the clinical efficacy of mitoxantrone treatment over 2 years. Patients were allocated either to the mitoxantrone group (27 patients receiving IV infusion of mitoxantrone every month for 1 year at the dosage of 8 mg/m²) or to the placebo group (24 patients, receiving IV infusion of saline every month for 1 year) using a centralized randomization system. Disability at entry and at 12–24 months was evaluated by four blinded neurologists trained in the application of the Kurtzke Expanded Disability Scale (EDSS). In addition, the number and clinical characteristics of the exacerbations over the 24 months were recorded by the local investigators. MRI, at 0,12 and 24 months, was performed with a 0.2 T permanent unit. MRI data were analysed by two blinded neuroradiologists. All patients underwent a clinical evaluation. A statistically significant difference in the mean number of exacerbations was observed between the mitoxantrone group and placebo group both during the 1st and the 2nd year. Although there was no statistically significant benefit in terms of mean EDSS progression over 2 years, the proportion of patients with confirmed progression of the disease, as measured by a one point increase on the EDSS scale, was significantly reduced at the 2nd year evaluation in the mitoxantrone group. Forty-two (23 mitoxantrone, 19 placebo) patients underwent all MRI examinations during the 24-month period. We observed a trend towards a reduction in the number of new lesions on T2-weighted images in the mitoxantrone group. Our study suggests that mitoxantrone might be effective in reducing disease activity, both by decreasing the mean number of exacerbations and by slowing the clinical progression sustained by most patients after 1 year from the end of treatment. Received: 22 February 1996 Received in revised form: 20 August 1996 Accepted: 20 September 1996     

Outcome in children with severe head injuries

We present a series of 56 children who suffered severe head injuries, with a Glasgow Coma Score (GCS) of less than 8. The cases were classified according to the type of morphologic lesion on computed tomography (CT) scan. Intracranial pressure (ICP) was monitored in all children in this series. A protocol that included artificial ventilation and other measures of treatment for intracranial hypertension was applied. Results were analyzed according to age, type of lesion, and ICP. The usefulness of the ICP recording and of obtaining a correct classification of lesions using the CT scan is emphasized.     

Ocular complications of head injury in children

Ocular complications occurred in 28% of children with head injury. Neuro-ophthalmological lesions made up one-third of these complications, mostly involved the optic nerve, and were associated with other focal neurological signs more frequently than non-neural ocular complications. Lesions of the posterior visual pathways were rare but tended to be permanent.     

MRI findings in the young infant with brainstem disconnection and extracerebral features. Report of one case and review of the literature

We present the young infant with the extremely rare brain abnormality–brainstem disconnection. Additionally, several extracerebral abnormalities were diagnosed: bilateral anotia, micrognatia, hypertelorism, scoliosis, ribs and vertebral anomalies. MR brain examination precisely demonstrated absence of the pons, with disruption between midbrain and hypoplastic medulla oblongata. The thin strands connecting the medulla with the midbrain and medulla with both cerebellar hemispheres were revealed. The large hamartoma of the tuber cinereum was found. In this study we review case reports published previously.     

急性一氧化碳中毒后迟发性脑病的临床与头颅磁共振改变

目的探讨急性一氧化碳中毒后迟发性脑病(DEACMP)患者的头颅磁共振成像(MRI)特点和诊断价值。方法分析24例DEACMP患者的临床表现、头颅MRI资料。结果DEACMP患者的主要临床表现为智能、人格改变;头颅MRI表现为脑室周围白质和半卵圆中心双侧对称的点状、斑片状或融合性病灶,T2加权像呈高信号,T1加权像呈低信号,基底节或苍白球区呈慢性缺血性改变,偶见病灶主要位于大脑皮质。结论本病的诊断主要依靠病史、临床表现和头颅磁共振改变。     

Craniopharyngiomas in children: Turkey experience

Objectives Craniopharyngiomas are the most frequently encountered suprasellar tumors in children. Although they have a benign histology, total resection without morbidity is very difficult.Methods We aimed to review the results of pediatric craniopharyngioma patients treated in eight institutions in Turkey. There were 51 boys and 36 girls, ranging in age from 20 months to 18 years (mean 10.2 years). The most frequent symptom was headache, followed by visual disturbances. Hydrocephalus was seen most frequently in tumors greater than 4 cm in size (P=0.002). Hydrocephalus was associated with the decreased gross total resection (P=0.043). The recurrence (28%) was significantly higher in patients with subtotal and partial tumor removal (P=0.010). Bad outcome was significantly associated with tumor dimension (P=0.039); the greater the tumor dimension, the worse the outcome. Outcome was significantly better in patients older than 10 years (P=0.032). Gender, tumor type and location, presence of hydrocephalus and calcification, histological type of craniopharyngioma, and surgical approach did not have a significant effect on the outcome.Conclusions The treatment should be individualized and a multidisciplinary approach should be used. The goal of surgery should be gross total removal without mortality and with acceptable morbidity.