Download Evidence-based Neuroimaging for Traumatic Brain Injury~ Is the

Evidence-based Neuroimaging
for Traumatic Brain Injury~
Is the approach to imaging of
children different?
2007/01/23
Intern 洪柏聖
The causes of traumatic brain
injury in children
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Falls(73% in British study)
Motor vehicle crashes
Pedestrian and bicycle accidents
Assaults
Sports-related trauma
Abuse (shaking… )
What images can we use?
• X-ray
-bony lesion
• CT
-acute neurologic presentations
-hemorrhage
-scalp injury
-pneumocephalus
-hydrocephalus, midline shift, mass, ischemia,
herniation
What images can we use?
• MRI
-brain anatomy and function
-timing and localization of hemorrhage
-intraparenchymal injury (edema, hematoma, contusion,
diffuse axonal injury)
-brain stem and posterior fossa
-sequelae of head trauma
-MRA: vascular injury
What images can we use?
• Ultrasound
-extracerebral fluid collections in infants
• Nuclear medicine
-SPECT (single photon eission computed tomography)
demonstrate focal, multifocal, or regional areas of hypoperfusion in
patients with brain injury in the acute (< 24 hours) and chronic phases
when compared to CT
-FDG-PET imaging: decrease in the regional cerebral metabolic
rate of glucose in traumatic brain injuries
Children <2y/o
-High risk (For head CT):
• Persistent vomiting
• Seizure
• Prolonged loss of consciousness
• Depressed mental status
• Focal neurologic findings
• Acute skull fracture, including depressed or basilar fracture
• Irritability
• Bulging fontanel
• Suspicion of child abuse
• Underlying condition predisposing to intracranial injury
-<3m/o
• with nontrivial trauma
Children <2y/o
-Intermediate-risk (OBS or CT):
• Vomiting
• Loss of consciousness
• History of lethargy or irritability, now resolved
• Behavioral change reported by caregiver
• Skull fracture more than 24 hours old (nonacute)
 Presence of more than one of the intermediate-risk factors
noted above
 Significant or prolonged behavioral change
 Clinical deterioration
 Large nonfrontal scalp hematomas, especially in those
younger than 12 months
Children <2y/o
-Low risk (no necessary):
• The mechanism of injury is a fall from less
than three feet.
• There has been no loss of consciousness or
seizure.
• The infant is asymptomatic for at least two
hours after the event.
• There is no scalp hematoma or only a frontal
scalp hematoma.
Children >2y/o
-Head CT:
• Focal neurologic findings
• Skull fracture
• Those who have had a seizure
• Depressed mental status at initial
evaluation
• Prolonged loss of consciousness
Children >2y/o
-OBS or head CT:
• Vomiting
• Headache
• Loss of consciousness without other
signs or symptoms
Children >2y/o
-No neuroimaging:
• Normal mental status
• Normal neurologic examination
• No evidence of a skull fracture
• No seizure, significant headache,
vomiting, or loss of consciousness
• No underlying condition predisposing to
intracranial injury
References
• Imaging of pediatric head trauma,Tina Young Poussaint, MD*,
Karen K. Moeller, MD, Neuroimag Clin N Am 12 (2002) 271–
294
• Comparison of Accidental and Nonaccidental Traumatic Head
Injury in Children on Noncontrast Computed Tomography,
Downloaded from www.pediatrics.org at Sheng Li Rd Med Lib
on January 21, 2007
• UptoDate 14.3, 2007