Cerebral complications of nonaccidental head injury in childhood

被引:63
作者
Gilles, EE
Nelson, MD
机构
[1] Ohio State Univ, Childrens Hosp, Dept Pediat & Neurol, Columbus, OH 43205 USA
[2] Univ So Calif, Childrens Hosp, Sch Med, Dept Radiol, Los Angeles, CA USA
关键词
D O I
10.1016/S0887-8994(98)00038-1
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Patterns of cerebral parenchymal injury and their relationship to outcome morbidity are evaluated in this retrospective study of 14 children with confirmed nonaccidental head injury (NAHI), The mean age at time of injury was 12 months 6 days, mean Children's Coma Score was 5.36, and mean postinjury follow-up was 17 months 12 days. All patients had acute subdural hematoma (interhemispheric or convexity) on initial CT imaging. Two major groups of children were identified from initial CT scans; those with diffuse cerebral hypoattenuation (n = 7) and those with focal cerebral hypoattenuation (n = 7), The two groups differed significantly by age (diffuse group, mean age 5 months 9 days +/- 36 days; focal group, mean age 19 months 3 days +/- 6 months 9 days; P < 0.01) and ultimate type and extent of parenchymal damage. Outcome was generally poor in both groups (mean Children's Outcome Score of III/IV), Cerebral infarction developed in all survivors. Most common were hemispheric necrosis after hemispheric swelling subjacent to an ipsilateral convexity acute subdural hematoma (n = 5); distribution of the posterior cerebral artery (n = 4) or callosomarginal branch of the anterior cerebral artery (n = 4); and borderzone infarctions (n = 4), Of 14 children, 11 (79%) had early posttraumatic seizures (EPTS), Clinical progression of symptoms was confirmed in nine patients (mean Childrens Coma Score was 4.0 +/- 0.33), None had a lucid interval. This is the first study using strict inclusion criteria that documents the range of infarction patterns and potential age-dependent differences in postinjury response cascades after nonaccidental head injury. (C) 1998 by Elsevier Science Inc. All rights reserved.
引用
收藏
页码:119 / 128
页数:10
相关论文
共 41 条
[1]  
Adelson PD, 1997, PEDIATR NEUROSURG, V26, P200
[2]   A model of diffuse traumatic brain injury in the immature rat [J].
Adelson, PD ;
Robichaud, P ;
Hamilton, RL ;
Kochanek, PM .
JOURNAL OF NEUROSURGERY, 1996, 85 (05) :877-884
[3]   DIFFERENT CEREBRAL HEMODYNAMIC-RESPONSES FOLLOWING FLUID PERCUSSION BRAIN INJURY IN THE NEWBORN AND JUVENILE PIG [J].
ARMSTEAD, WM ;
KURTH, CD .
JOURNAL OF NEUROTRAUMA, 1994, 11 (05) :487-497
[4]   STRANGULATION IN CHILD-ABUSE - CT DIAGNOSIS [J].
BIRD, CR ;
MCMAHAN, JR ;
GILLES, FH ;
SENAC, MO ;
APTHORP, JS .
RADIOLOGY, 1987, 163 (02) :373-375
[5]  
Bonnier C, 1995, DEV MED CHILD NEUROL, V37, P943
[6]  
CHESNUT RM, 1993, ACTA NEUROCHIR, P121
[7]  
COHEN RA, 1985, AM J NEURORADIOL, V6, P883
[8]   Long-term outcome in infants with the shaking-impact syndrome [J].
Duhaime, AC ;
Christian, C ;
Moss, E ;
Seidl, T .
PEDIATRIC NEUROSURGERY, 1996, 24 (06) :292-298
[9]   THE SHAKEN BABY SYNDROME - A CLINICAL, PATHOLOGICAL, AND BIOMECHANICAL STUDY [J].
DUHAIME, AC ;
GENNARELLI, TA ;
THIBAULT, LE ;
BRUCE, DA ;
MARGULIES, SS ;
WISER, R .
JOURNAL OF NEUROSURGERY, 1987, 66 (03) :409-415
[10]   Histologic studies of the brain following head trauma III. Post-traumatic infarction of cerebral arteries, with consideration of the associated clinical picture [J].
Evans, JP ;
Scheinker, IM .
ARCHIVES OF NEUROLOGY AND PSYCHIATRY, 1943, 50 (03) :258-278