Delayed and Progressive Brain Injury in Children and Adolescents with Head Trauma

Stein, Sherman C.; Spettell, Claire M.

doi:10.1159/000120975

Cited by 62 publications

(44 citation statements)

References 36 publications

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“…In pediatric guidelines and retrospective pediatric studies of all traumatic brain injuries, repeat imaging is recommended for some observed patients given concern for progression of injury [8,16,24,25,26,27]. While repeat imaging was common in our study population, the initial repeat CT image showed an increase in hematoma size in a minority of patients and led to surgery in only 1 patient.…”

Section: Discussionmentioning

confidence: 92%

Utility of Clinical and Radiographic Findings in the Management of Traumatic Epidural Hematoma

Flaherty¹,

Loya²,

Alexander³

et al. 2013

Pediatr Neurosurg

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Background: There are currently no clear guidelines for the management and radiological monitoring of pediatric patients with epidural hematomas (EDH). We aim to compare clinical and radiographic characteristics of pediatric EDH patients managed with observation alone versus surgical evacuation and to describe results of repeat head imaging in both groups. Methods: We performed a retrospective observational study of pediatric patients diagnosed with traumatic EDH at a level II trauma center. Results: Forty-seven cases of EDH were analyzed. Sixty-two percent were managed by observation alone. Patients undergoing surgery were more likely to have an altered mental status (17 vs. 72%, p < 0.001), but there were no other significant clinical differences between the groups. The mean initial EDH thickness and volume were 8.0 mm and 8.6 ml in the observed group and 15.5 mm and 35 ml in the surgery group, respectively (p < 0.001 for both comparisons). Eighty-six percent of the observed and all surgery patients underwent repeat CT imaging. The initial repeat CT scan results led to surgery in 1 patient who was initially treated with observation. Conclusions: Most pediatric patients with EDH can be managed with observation. Mental status and radiographic findings should guide the need for surgical intervention. Multiple repeat CT scans have minimal utility in changing management.

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Section: Discussionmentioning

confidence: 92%

Utility of Clinical and Radiographic Findings in the Management of Traumatic Epidural Hematoma

Flaherty¹,

Loya²,

Alexander³

et al. 2013

Pediatr Neurosurg

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“…These evolving lesions consist of extraaxial hematomas and intracerebral hematomas. There have also been multiple recommendations for repeat scans after the initial head CT [8,12,13].…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy of serial computed tomographic scanning in pediatric severe traumatic brain injury

et al. 2005

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The purpose of this study is to determine whether serial computed tomography (CT) scans of the head lead to operative intervention in pediatric patients with severe traumatic brain injury (TBI). Serial CT scans are those done in addition to the initial CT scan and one follow up CT scan in the first 24-48 h. This study is a retrospective review from January 1990 to December 2003. The hospital course was reviewed for 942 pediatric patients with traumatic brain injuries. Of these, 40 patients were identified who met the following criteria: age less than 18, admission, Glasgow Coma Scale (GCS) < or = 8, intra-cranial pressure (ICP) monitoring during hospitalization, no craniotomy at admission, and at least one serial CT scan after the first 48 h. One hundred fifteen serial CT scans were ordered. Eighty-seven were ordered for routine follow up, 24 were ordered for increased ICP, and 4 were ordered for neurologic change. One craniotomy and one burr hole were performed based on serial CT scans ordered for increased ICP. Serial CT scans, beyond the initial and follow-up scans, have a limited role in children with severe TBI. In this series, only serial CT scans ordered for increased ICP (21%) and neurologic deterioration (3%) led to operative interventions. Serial scans ordered for routine follow-up (76%) resulted in no operative interventions.

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“…[7][8][9][10] Two pathogenetic mechanisms for secondary traumatic damage stand out among those proposed, excitotoxicity and apoptosis. 8 -35 Blocking each of these processes elicits protective effects in experimental models for brain and spinal cord trauma.…”

mentioning

confidence: 99%

Apoptotic neurodegeneration following trauma is markedly enhanced in the immature brain

et al. 1999

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Age dependency of apoptotic neurodegeneration was studied in the developing rat brain after percussion head trauma. In 7‐day‐old rats, mechanical trauma, applied by means of a weight drop device, was shown to trigger widespread cell death in the hemisphere ipsilateral to the trauma site, which first appeared at 6 hours, peaked at 24 hours, and subsided by 5 days after trauma. Ultrastructurally, degenerating neurons displayed features consistent with apoptosis. A decrease of bcl‐2 in conjunction with an increase of c‐jun mRNA levels, which were evident at 1 hour after trauma and were accompanied by elevation of CPP 32‐like proteolytic activity and oligonucleosomes in vulnerable brain regions, confirmed the apoptotic nature of this process. Severity of trauma‐triggered apoptosis in the brains of 3‐ to 30‐day‐old rats was age dependent, was highest in 3‐ and 7‐day‐old animals, and demonstrated a subsequent rapid decline. Adjusting the mechanical force in accordance with age‐specific brain weights revealed a similar vulnerability profile. Thus, apoptotic neurodegeneration contributes in an age‐dependent fashion to neuropathological outcome after head trauma, with the immature brain being exceedingly vulnerable. These results help explain unfavorable outcomes of very young pediatric head trauma patients and imply that, in this group, an antiapoptotic regimen may constitute a successful neuroprotective approach. Ann Neurol 1999;45:724–735

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Delayed and Progressive Brain Injury in Children and Adolescents with Head Trauma

Cited by 62 publications

References 36 publications

Utility of Clinical and Radiographic Findings in the Management of Traumatic Epidural Hematoma

Utility of Clinical and Radiographic Findings in the Management of Traumatic Epidural Hematoma

Clinical efficacy of serial computed tomographic scanning in pediatric severe traumatic brain injury

Apoptotic neurodegeneration following trauma is markedly enhanced in the immature brain

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