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[Diffuse axonal lesions in childhood].

A Chiaretti1, M Visocchi, L Viola

  • 1Sezione Autonoma di Terapia Intensiva Pediatrica, Università Cattolica Sacro Cuore di Roma.

La Pediatria Medica E Chirurgica : Medical and Surgical Pediatrics
|May 21, 1999
PubMed
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Diffuse Axonal Injury (DAI) in children leads to severe outcomes, with most patients experiencing persistent vegetative states or significant neurological deficits. Monitoring cerebral blood flow is crucial for managing DAI patients.

Area of Science:

  • Pediatric Neurology
  • Traumatic Brain Injury Research
  • Neurocritical Care

Background:

  • Diffuse Axonal Injury (DAI) constitutes a significant portion of traumatic brain injuries, often resulting in coma and severe long-term deficits.
  • The prognosis for DAI is generally poor, with high mortality and morbidity rates.

Observation:

  • This study evaluated cerebral hemodynamics and neuroradiological findings in four pediatric patients with DAI.
  • Patients were admitted to the Pediatric Intensive Care Unit with a Glasgow Coma Score (GCS) of 5 and received intensive medical management.
  • Serial CT scans and Transcranial Doppler Sonography (TCD) were performed, alongside intracranial pressure monitoring.

Findings:

  • Three out of four pediatric patients with DAI achieved a Glasgow Outcome Score (GOS) of 2, indicating a persistent vegetative state.

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  • One patient had a GOS of 3, signifying severe neurological deficits.
  • The study highlights the unfortunate prognosis associated with DAI in children.

    • Implications:

    • Effective management of DAI necessitates continuous monitoring of cerebral blood flow.
    • Techniques such as Transcranial Doppler Sonography (TCD) and evaluations of SjO2 and CEO2 are recommended for optimizing patient care.
    • DAI presents substantial healthcare challenges due to its severity and long-term consequences.