No abstract

No abstract

No abstract

To investigate the relationship of severity of pediatric closed head injury (CHI), the contribution of frontal lobe lesions, and age at testing (6-10 years old vs. 11-15 years old) to cognitive deficit, 134 head-injured patients were given the Tower of London (TOL) task and underwent magnetic resonance imaging. Eighty-nine normal controls were given the TOL for comparison. Severity of CHI and age at testing were strongly related to cognitive performance on the TOL, including the frequency of breaking the rules. Volume of frontal lobe lesion (but not extrafrontal lesion) contributed to the prediction of performance on the TOL even after severity of injury was taken into account. Luria (1966) proposed that formulating a plan of action, monitoring problem-solving behaviors by verbal regulation, and verifying goal attainment are among the distinct capacities of the prefrontal region, a view that has received support from case reports of adults (Cicerone & Woods, 1987;Eslinger & Damasio, 1985) and investigation of patients following frontal excisions for intractable epilepsy (Petrides & Milner, 1982). Major gains in cognitive functions, such as planning and flexibility in reasoning, in 6-to 12-year-old children have been attributed to maturation of the prefrontal region (

To characterize the brain pathology in relation to long-term outcome after pediatric head injury, 55 children were studied by magnetic resonance imaging (MRI) at least 3 months after sustaining moderate to severe closed head injury (CHI). Thirty-nine of the patients had abnormal signal intensity consistent with residual brain lesions, including 28 children with lesions involving the frontal lobes. The clinical features of children with frontal lesions, extrafrontal lesions, and diffuse injury were compared. The analysis disclosed that children with frontal lobe lesions were more frequently disabled than children who sustained diffuse injury. Our MRI findings indicate that residual brain lesions are more common after moderate to severe CHI in children than previously thought and that the frontal lobes are most frequently involved. Further investigation is indicated to elucidate whether distinctive cognitive and behavioral sequelae are associated with frontal lobe lesions in children.