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Computerised axial tomography and acute neurological problems of childhood
Insights
Computerised axial tomography (CAT) effectively identifies intracranial pathology in children with neurological symptoms. While abnormal in most space-occupying lesions and infections, CAT may be normal in early brain stem gliomas or small subdural collections.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Medical Imaging
Background:
- Neurological symptoms in children necessitate accurate diagnostic tools.
- Computerised axial tomography (CAT) is a key imaging modality for evaluating intracranial conditions.
Purpose of the Study:
- To evaluate the diagnostic utility of CAT in children presenting with neurological symptoms.
- To correlate CAT findings with specific intracranial pathologies and clinical presentations.
Main Methods:
- Retrospective analysis of 80 children with neurological symptoms/signs of <3 months duration.
- Review of CAT scan results in relation to diagnosed intracranial pathology and clinical presentation.
Main Results:
- CAT scans were abnormal in 25/26 children with space-occupying lesions (tumor, abscess, hemorrhage, infarct).
- 12/20 children with meningitis/encephalitis showed abnormal CAT scans.
- Only 4/34 children with less definite or no intracranial disease had abnormal scans.
- Persistent neurological signs correlated with a higher rate of abnormal CAT scans (29/42).
- No intracranial lesions requiring specific treatment were missed in children with symptoms alone or signs <24 hours.
Conclusions:
- CAT is valuable for demonstrating the site, size, and nature of many intracranial lesions in children.
- CAT is highly sensitive for space-occupying lesions and infections but may have limitations in early brain stem gliomas or small subdural collections.
Abstract:
The results of computerised axial tomography (CAT) in 80 children with neurological symptoms and/or signs of less than 3 months' duration are discussed in relation firstly to intracranial pathology and secondly to clinical presentation. 26 children had intracranial space-occupying lesions (tumour, abscess, haemorrhage, infarct). CAT was abnormal in 25 of these and diagnostic in 18. A further 20 children had meningitis or encephalitis, and CAT was abnormal in 12. In contrast with this high rate of scans showing pathology, CAT was abnormal in only 4 of the remaining 34 children who had less definite or no intracranial disease. Analysis of clinical presentation showed that 42 of 69 children presented with persisting neurological signs and of these, 25 had an intracranial space-occupying lesion and 29 had abnormal CAT. Only 5 of 27 children who had symptoms alone or signs lasting less than 24 hours had abnormal CAT, and no intracranial lesion requiring specific treatment was missed. CAT is useful for demonstrating the site, size, and nature of many lesions. The scan may not initially be abnormal in brain stem gliomas and in small subdural collections of fluid.
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