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CT and MR imaging of primary cerebrovascular complications in pediatric head trauma
M Steinborn1, C Schäffeler, C Kabs
1Department of Diagnostic and Pediatric Radiology, Städtisches Klinikum Munich-Schwabing, Koelner Platz 1, 80804, Munich, Germany. steinborn@lrz.tum.de
Insights
Severe traumatic head injuries in children can cause rare cerebrovascular complications. Radiologists must recognize specific injury patterns and imaging timelines on CT and MRI for accurate diagnosis.
Area of Science:
- Pediatric Radiology
- Neuroimaging
- Trauma Imaging
Background:
- Severe traumatic head injury incidence in children is increasing.
- Diagnostic imaging, including MRI, is crucial for intracranial lesion assessment.
- Early MRI enhances understanding of posttraumatic intracranial injuries.
Purpose of the Study:
- To retrospectively analyze CT and MR imaging in children with traumatic head injuries.
- To identify primary cerebrovascular complications following pediatric head trauma.
- To evaluate the role of imaging in detecting these rare complications.
Main Methods:
- Retrospective analysis of cranial CT and MR studies in 64 pediatric patients.
- Patients aged 3 months to 15 years with traumatic head injuries.
- Imaging performed at various intervals post-trauma (CT on admission, MRI 0-120 days).
Main Results:
- Cerebrovascular complications were identified in 7.8% (5/64) of patients.
- Findings included middle cerebral artery infarction, extensive sinus thrombosis, and pericallosal artery aneurysm.
- Delayed onset of sinus thrombosis (4-6 days) and aneurysm (30 days) noted on MRI.
Conclusions:
- Primary cerebrovascular lesions are rare but significant complications of pediatric traumatic head injury.
- Radiologists need awareness of characteristic injury patterns and temporal imaging findings on CT and MRI.
- Timely and appropriate imaging is essential for diagnosing these complications.
Abstract:
The incidence of severe traumatic head injury in children has constantly increased over the last years. Diagnostic imaging has become an unrenounceable tool for the documentation and follow-up of intracranial lesions. The use of magnetic resonance imaging (MRI) in the early posttraumatic phase has led to a more thorough understanding of intracranial injuries. We retrospectively analyzed the cranial computed tomography (CCT) and magnetic resonance (MR)-studies of patients with traumatic head injuries for primary cerebrovascular complications. In 64 children (45 male, 19 female) with traumatic head injuries, CCT and MR examinations were available for analysis. The children's age ranged from 3 months to 15 years with a median age of 7 years. All patients had initial CCT on admission to the hospital with follow-up examinations depending on clinical state and initial imaging findings. All patients had at least one MR examination between 0 to 120 days after the trauma with a median time interval of 17 days. In five of 64 (7.8%) patients, cerebrovascular complications were found on imaging studies. Initial imaging within the first 24 h after the trauma detected a complete middle cerebral artery infarction in one patient and extensive sinus thrombosis after a complex skull fracture in another. In two patients, thrombosis of the transverse sinus appeared on MRI 4 to 6 days after the trauma. In another patient with open-skull injury, a posttraumatic aneurysm of the pericallosal artery was diagnosed on MRI 30 days after the trauma. Our study shows that, although primary cerebrovascular lesions after traumatic head injuries in children are rare, the radiologist should be aware of the characteristic injury patterns and the time appearance of imaging findings on CT and MRI.
