Is medial temporal injury responsible for pediatric postconcussion syndrome? A prospective controlled study with
Deepak Agrawal1, Naveen K Gowda, Chandra S Bal
1Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
Insights
Medial temporal hypoperfusion (MTH) is significantly present in children with persistent postconcussion syndrome (PPCS) after head injury. Brain SPECT scans can identify children at risk for PPCS.
Area of Science:
- Neuroscience
- Radiology
Background:
- Pediatric persistent postconcussion syndrome (PPCS) is a challenging clinical issue.
- Medial temporal hypoperfusion (MTH) is a potential imaging biomarker.
Purpose of the Study:
- To correlate medial temporal hypoperfusion (MTH) on SPECT scans with pediatric persistent postconcussion syndrome (PPCS).
- To evaluate the clinical utility of SPECT for identifying children at risk for PPCS.
Main Methods:
- Thirty children with minor head injury and PPCS underwent initial SPECT scans.
- Patients were divided into MTH (test) and control groups, with repeat SPECT scans after 3 months.
- Clinical assessment of PPCS incidence was performed in both groups.
Main Results:
- Persistent MTH was observed in 93% of the test group, with no new MTH in the control group.
- PPCS incidence was significantly higher in the MTH group (12/14) compared to the control group (2/16).
- Relative risk of PPCS in the MTH group was 6.86 (p=0.0003).
Conclusions:
- Significant MTH is associated with pediatric PPCS, suggesting medial temporal lobe damage.
- Brain SPECT scans may aid in early identification of children prone to developing PPCS.
- Serial SPECT scans can serve as a platform for evaluating treatment efficacy in PPCS.
Object:
The authors sought to correlate the finding of medial temporal hypoperfusion (MTH) demonstrated on single photon emission computerized tomography (SPECT) with pediatric persistent postconcussion syndrome (PPCS) and to ascertain its usefulness in routine clinical practice.
Methods:
Thirty consecutive children with minor head injury and features of PPCS underwent SPECT scanning within 72 hours of injury. Those children having MTH on SPECT were included in the test group (14 patients), and the remaining 16 children comprised the control group. At the end of a 3-month period SPECT scanning was repeated and the incidence of PPCS was assessed clinically in both groups. Repeated SPECT scanning at 3 months revealed persisting MTH in 13 children (93%) in the test group; no child developed MTH in the control group. Twelve children were found to have PPCS in the MTH group compared with only two in the control group, and this was highly statistically significant (relative risk 6.86 [95% confidence interval 1.84-25.51], p = 0.0003).
Conclusions:
There exists significant MTH in pediatric patients with PPCS, which would imply that medial temporal lobe damage (involving the hippocampus and related structures) may occur after minor head injury and could be responsible for the symptoms of PPCS observed in this group of patients. Brain SPECT scans may thus help in the early identification of children prone to develop PPCS, and serial SPECT scanning may serve as a platform for testing the efficacy of various neurobehavioral and pharmacological interventions in these patients.
