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[Spectacular neurologic manifestations after mild head trauma: retrospective study on 51 children]
M Bru1, V Nouyrigat, P Landrieu
1Service de neurologie pédiatrique, service des urgences pédiatriques, hôpital Bicêtre, Assistance-publique-Hôpitaux-de-Paris, 94270, France.
Insights
Mild head trauma in children can cause unusual symptoms like syncope or seizures, even without brain injury. Many cases suggest a link to migraine, with most children experiencing normal development and academics.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Traumatology
Context:
- Mild head traumas often present with minimal or no symptoms.
- However, some children develop significant neurological manifestations despite the absence of intracranial lesions.
Purpose:
- To retrospectively study 51 children with mild head trauma and significant neurological symptoms.
- To clarify the long-term follow-up and outcomes in these cases.
Summary:
- The study identified various symptoms including syncope-like loss of consciousness, seizures, severe headaches with neurological signs, confusion, visual disorders, and amnesic ictus.
- Recurrences were generally benign. A significant portion of children in certain groups developed common migraine.
- Most children maintained normal academic performance, with only one case developing epilepsy.
Impact:
- Findings suggest a potential migrainous pathogeny in some post-traumatic episodes, possibly related to brain maturation.
- The study supports avoiding further investigations in mild head trauma cases with normal CT scans and examinations once symptoms resolve.
Unlabelled:
Mild head traumas, as a rule, remain a- or paucisymptomatic. In a few cases however, spectacular manifestations develop despite absence of intracerebral lesion. POPULATION, METHODS: We have studied retrospectively 51 such children and contacted their family in order to clarify the follow-up.
Results:
The dominant symptoms allowed to categorize the following situations: syncope-like loss of consciousness (11 cases), seizures (6), severe headaches with neurologic signs (15), confusion (8), visual disorders (6), amnesic ictus (5). Recurrences were possible but benign: in 8/11 children in the group "syncopes", in 1/6 in the group "seizures", in 5/21 in the 4 other groups. In the latter 4 groups, 11/21 children developed common migraine. Except for the only case who developed epilepsy later on, scholarship was normal in the 25 cases with sufficient follow-up.
Discussion:
Beside syncopes and seizures, the long-lasting episodes suggested a migrainous pathogeny, perhaps at a maturative stage where the trigger of migrainous mechanism is at a low level in the brain.
Conclusion:
The mildness of the knock, the normality of CT scan including when the symptoms are present and the normality of both consciousness and examination once the symptoms have disappeared allow to avoid further investigations.
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