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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 • • • • • • 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