Tectorial membrane injury: frequently overlooked in pediatric traumatic head injury

Area of Science:

• Pediatric Radiology
• Neuroradiology
• Trauma Imaging

Background:

• Rupture of the extra-axial space (REH) and tectorial membrane injuries are uncommon yet significant complications of pediatric head and neck trauma.
• These injuries often occur in the context of high-energy mechanisms, such as motor vehicle accidents (MVAs).

Purpose of the Study:

• To characterize the neuroimaging findings associated with pediatric REHs.
• To elucidate the common mechanisms of injury.
• To correlate imaging findings with clinical presentations in children.

Main Methods:

• Retrospective analysis of CT and/or MR imaging studies.
• Inclusion of 10 pediatric patients diagnosed with traumatic REH.
• Review of injury mechanisms and clinical data.

Main Results:

• The majority of patients (80%) had medium to large REHs.
• Tectorial membrane injury was present in 70% of cases.
• No focal spinal cord, brainstem injury, craniocervical junction dislocation, or vertebral fractures were identified.
• Tectorial membrane disruption was observed even in patients without overt craniocervical symptoms.

Conclusions:

• Pediatric REHs and associated tectorial membrane injuries are linked to high-speed head and neck trauma.
• Clinical symptoms can be subtle or deceptive, underscoring the importance of radiologist awareness.
• MRI demonstrates superior sensitivity compared to CT for detecting these injuries.