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An unusual syndrome of pediatric brainstem trauma
1Department of Neurosurgery, State University of New York, Syracuse.
Insights
Delayed hemiparesis in children after minor head trauma can occur. This condition may stem from brainstem artery damage leading to vasospasm, with patients typically recovering quickly.
Area of Science:
- Neurology
- Pediatric Neurology
- Neuroimaging
Background:
- Minor closed head injuries in children can present with delayed neurological deficits.
- The diagnostic challenges of subtle pediatric head trauma require advanced imaging techniques.
Observation:
- Two pediatric cases presented with delayed hemiparesis post-minor head injury.
- Initial computed tomography (CT) scans were normal, with no loss of consciousness.
- Magnetic resonance imaging (MRI) revealed focal lesions in the ventral pons contralateral to the affected side.
Findings:
- The observed lesions suggest a specific pattern of brainstem injury.
- The contralateral presentation of pontine lesions to hemiparesis is a key finding.
- Recovery to near-normal neurologic function occurred within days for both patients.
Implications:
- A potential mechanism involves focal contusion of perforating brainstem arteries.
- Delayed vasospasm secondary to arterial injury is postulated.
- These findings highlight the importance of MRI in evaluating delayed neurological deficits after head trauma in children.
Abstract:
We report 2 cases of children who developed a delayed hemiparesis following minor closed head injury with no alteration in consciousness and normal CT studies. MRI showed focal lesions in the ventral pons contralateral to the hemiparesis. Both patients recovered to near normal neurologic function within several days of injury. We postulate a mechanism of injury based on focal contusion of perforating brainstem arteries resulting in the delayed onset of vasospasm.