Neurobehavioural dysfunction following mild traumatic brain injury in childhood: a case report with positive findings on positron emission tomography (PET).
The present case study describes the neurobehavioural, neurodiagnostic, and positron emission tomography (PET) scan findings in a child who sustained a whiplash-type injury in a motor vehicle accident. Although neck and back pain were reported immediately, neurobehavioural symptoms, such as staring spells, gradually increased in frequency over a 2-year period following the accident. At 4 years after the accident the patient's symptoms persisted, as reported by teachers and parents, and more extensive diagnostic work-up was initiated. Standard EEG was normal while two ambulatory EEGs were abnormal and interpreted as epileptiform. A PET scan showed evidence of marked hypometabolism in both temporal lobes. Neuropsychological findings were consistent with PET findings and reflected verbal and visual memory deficits in the context of high average intelligence. Treatment with carbamazepine, verapamil, and fluoxetine greatly improved the patient's symptoms. The present case illustrates an example of a poor outcome in a paediatric case of mild traumatic brain injury, the importance of PET in demonstrating definitive evidence of brain dysfunction, and the child's positive response to anticonvulsant medication.
Roberts
M A
MA
Department of Pediatrics, University of Iowa College of Medicine, USA.
Manshadi
F F
FF
Bushnell
D L
DL
Hines
M E
ME
D000063:Accidents, Traffic; D000927:Anticonvulsants / Q000627:therapeutic use; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D001924:Brain Concussion / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology; D001925:Brain Damage, Chronic / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology; D002220:Carbamazepine / Q000627:therapeutic use; D002648:Child; D002653:Child Behavior Disorders / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology; D004569:Electroencephalography / Q000187:drug effects; D004734:Energy Metabolism / Q000187:drug effects / Q000502:physiology*; D004834:Epilepsy, Post-Traumatic / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D005473:Fluoxetine / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011939:Mental Recall / Q000502:physiology; D019965:Neurocognitive Disorders / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology; D009483:Neuropsychological Tests; D013702:Temporal Lobe / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000503:physiopathology; D014055:Tomography, Emission-Computed; D014665:Vasodilator Agents / Q000627:therapeutic use; D014700:Verapamil / Q000627:therapeutic use; D014911:Whiplash Injuries / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology
D000927:Anticonvulsants; D018687:Antidepressive Agents, Second-Generation; D014665:Vasodilator Agents; D005473:Fluoxetine; D002220:Carbamazepine; D014700:Verapamil