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Objective Head ultrasonography (HUS) is a reliable and easy to perform bedside imaging technique that can give valuable information about degree of brain injury/edema after perinatal asphyxia in term neonates. The goals of our study were to determine whether semiquantitative markers such as standardized white matter/gray matter (WM/GM) echogenicity ratio and resistive index (RI) value measured by HUS differs between asphyxiated term neonates and healthy controls. Study Design Thirty-one carefully selected term neonates who suffered from perinatal hypoxic-ischemic encephalopathy (HIE) were included in the study. The ratio of the WM/GM echogenicity of the cingulate gyrus was calculated. In addition, the RI value was measured in the anterior cerebral artery. US scalars were compared with 11 healthy neonates. Result WM/GM ratio is significantly increased and RI value significantly decreased in asphyxiated term neonates compared with healthy subjects. Conclusion WM/GM ratio and RI value allows discriminating between asphyxiated neonates and healthy subjects. These US scalars may serve as valuable, easy to acquire semiquantitative bedside markers of brain HIE, when magnetic resonance imaging is unavailable or cannot be performed in the acute setting.

SUMMARY:REHs and tectorial membrane injuries are rare complications of pediatric head and neck injuries. We aim to describe the neuroimaging findings in pediatric REHs, to summarize the mechanism of injury, and to correlate the imaging findings with the clinical presentation. We retrospectively evaluated CT and/or MR imaging studies of 10 children with traumatic REH. Most patients were involved in MVAs. The tectorial membrane was injured in 70% of patients, and REHs were medium to large in 80%. None of the patients had a focal spinal cord or brain stem injury, craniocervical junction dislocation, or vertebral fractures. Tectorial membrane disruption was diagnosed in most patients without craniocervical junctionϪrelated symptoms. Tectorial membrane lesions and REHs were seen in young children who sustained high-speed head and neck injuries. Clinical symptoms may be minimal or misleading. The radiologist should be aware of these injuries in children. MR imaging appears to be more sensitive than CT.ABBREVIATIONS: DAI ϭ diffuse axonal injury; GCS ϭ Glasgow Coma Scale; MVA ϭ motor vehicle accident; REH ϭ retroclival epidural hematoma; STIR ϭ short T1 inversion recovery R EH and tectorial membrane injuries are rare complications of traumatic head-neck injuries. Only 1.2%-12.9% of all posterior fossa epidural hematomas are located in the retroclival epidural space.1-5 REHs have only been reported in a few children and even more rarely in the adult population. 6,7 Most pediatric traumatic REHs are seen in children involved in MVAs.8 Tectorial membrane disruption has been reported to be 1 of the most important factors resulting in the formation of a REH. None of the previous reports, however, have systematically studied the simultaneous occurrence of REH and tectorial membrane injuries in children. 6 Conventional radiography and CT are typically used in acute trauma to exclude injury to the brain or cervical spine. Conventional radiography and CT may, however, not always detect craniocervical junction injuries adequately or may underestimate the degree and extent of injury. MR imaging is the technique of choice for the detailed assessment of craniocervical junction injuries. MR imaging also allows the evaluation of the lower brain stem and cervical spinal cord with higher sensitivity and specificity. 6,9 The goals of our report are the following: 1) to describe the CT and MR imaging features in children with confirmed traumatic REH, 2) to specifically assess the frequency of simultaneous REH and tectorial membrane injury, and 3) to correlate the imaging findings with the clinical presentation. Materials and MethodsTen children with confirmed REH by CT and/or MR imaging were included in the study. All children had experienced an acute significant head and neck injury and were seen at the Johns Hopkins Hospital between June 2006 and July 2010. The age and sex of all patients were recorded. The electronic patient records were reviewed for the following: 1) the mechanism of trauma (eg, fall, MVA), and 2) clinical signs on th...

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In this article, we hope to summarize current understanding of pediatric headache. We discuss epidemiology, genetics, classification, diagnosis, outpatient, emergency and inpatient treatment options, prevention strategies, and behavioral approaches. For each section, we end with a series of questions for future research and consideration.