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Post-traumatic bilateral diffuse cerebral swelling
1Department of Neurosurgery, Akdeniz University, Faculty of Medicine, Antalya, Turkey.
Insights
Severe head injuries cause diffuse cerebral swelling more often in children than adults. While outcomes are generally better for pediatric patients, those with associated hemorrhages face a worse prognosis.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Trauma Surgery
Background:
- Severe head injury (SHI) presents unique challenges in pediatric populations.
- Understanding differences in injury patterns between pediatric and adult SHI is crucial for targeted treatment.
Purpose of the Study:
- To compare the incidence and outcomes of diffuse cerebral swelling (DCS) in pediatric versus adult patients with SHI.
- To investigate the impact of parenchymal hemorrhages on DCS outcomes in different age groups.
Main Methods:
- Retrospective analysis of severe head injury patient data.
- Comparison of incidence rates for DCS with and without parenchymal hemorrhages between pediatric and adult cohorts.
- Evaluation of secondary neurological deterioration and mortality rates.
Main Results:
- DCS occurred more frequently in pediatric patients (42.55%) compared to adults (20.43%).
- Pediatric patients with SHI generally had better outcomes and lower mortality rates (12.5%) than adults (34.21%).
- Adults with DCS and small hemorrhages had a worse prognosis than pediatric patients with similar injuries.
Conclusions:
- Pediatric patients with severe head injury exhibit a higher incidence of diffuse cerebral swelling.
- While pediatric outcomes are generally favorable, the presence of hemorrhages significantly impacts prognosis in adults.
- Age is a critical factor influencing the presentation and outcome of diffuse cerebral swelling following severe head injury.
Abstract:
This study confirms that bilateral diffuse cerebral swelling with or without parenchymal haemorrhages (< 15 cc) is a more common occurrence in the paediatric patients with severe head injury as compared with adults, since the analysed sample represented 42.55% and 20.43% of all paediatric and adult patients with severe head injury recorded in our clinic at the time of the study, respectively. The incidence of patients with diffuse cerebral swelling without parenchymal haemorrhages was found to be 27.65% of paediatric patients and 5.37% of adult patients with severe head injury. Secondary neurological deterioration occurred only in 5 (12.5%) paediatric patients and in 4 (10.5%) adult patients with diffuse cerebral swelling and was not to be found associated with parenchymal haemorrhages. A better outcome was seen in paediatric patients. Mortality rates were 12.5% in paediatric patients and 34.21% in adult patients. Our data also suggest that the mortality rate between paediatric and adult patients with diffuse cerebral swelling without parenchymal haemorrhages was similar (15.38% and 20% in paediatric and adult group, respectively), while the adult patients with diffuse cerebral swelling associated with small intraparenchymal haemorrhages have a worse prognosis than paediatric patients.