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Frontal lobe changes after severe diffuse closed head injury in children: a volumetric study of magnetic resonance
P Berryhill1, M A Lilly, H S Levin
1Division of Neurosurgery, University of Maryland Medical System, Baltimore, USA.
Insights
Severe closed head injury (CHI) in children causes frontal lobe tissue loss, even without visible MRI lesions. This brain injury impacts gray matter volume and leads to long-term disability in many young patients.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Traumatic Brain Injury
Background:
- Severe closed head injury (CHI) in children can cause diffuse frontal lobe damage.
- Focal brain lesions are not always detected by magnetic resonance imaging (MRI) in pediatric CHI.
- Understanding morphological changes is crucial for assessing CHI severity and outcomes.
Purpose of the Study:
- To quantify the morphological effects of CHI on the frontal lobes in children.
- To compare frontal lobe changes in severe CHI versus mild head injury.
- To correlate volumetric findings with clinical outcomes in pediatric head trauma.
Main Methods:
- Compared MRI findings of 14 children with severe CHI (GCS ≤ 8) to 14 with mild head injury (GCS 13-15).
- Performed volumetric analysis of frontal lobe gray matter and cerebrospinal fluid at least 3 months post-injury.
- Assessed patient age range (5-15 years) and long-term functional outcomes.
Main Results:
- No focal MRI signal abnormalities were found in the frontal lobes of severe CHI patients.
- Severe CHI was associated with increased prefrontal cerebrospinal fluid and decreased gray matter volume.
- Reduced gray matter volume was observed in orbitofrontal and dorsolateral regions in severe CHI cases.
Conclusions:
- Severe CHI in children leads to prefrontal tissue loss, even without detectable focal MRI lesions.
- Volumetric changes in the frontal lobe correlate with the severity of head trauma.
- Long-term disability is common after severe CHI, highlighting the need for early intervention and management.
Abstract:
In view of the pathophysiology and biomechanics of severe closed head injury (CHI) in children, we postulated that the frontal lobes sustain diffuse injury, even in the absence of focal brain lesions detected by magnetic resonance imaging (MRI). This study quantitated the morphological effects of CHI on the frontal lobes in children who sustained head trauma of varying severity. The MRI findings of 14 children who had sustained severe CHIs (Glasgow Coma Scale score of < or = 8) were compared with the findings in a matched group of 14 children having sustained mild head injuries (Glasgow Coma Scale score of 13-15). The patients ranged in age from 5 to 15 years at the time of their MRIs, which were acquired at least 3 months postinjury. MRI findings revealed no focal areas of abnormal signal in the frontal lobes. Volumetric analysis disclosed that the total prefrontal cerebrospinal fluid increased and the gray matter volume decreased in the patients with severe CHI, relative to the mildly injured comparison group. Gray matter volume was also reduced in the orbitofrontal and dorsolateral regions of the brains of children with severe CHI, relative to the children who sustained mild head trauma. These volumetric findings indicate that prefrontal tissue loss occurs after severe CHI in children, even in the absence of focal brain lesions in this area. Nearly two-thirds of the children who sustained severe CHIs were moderately disabled after an average postinjury interval of 3 years or more, whereas 12 of the 14 patients with mild CHIs attained a good recovery (2 were moderately disabled) by the time of study.(ABSTRACT TRUNCATED AT 250 WORDS)