title: [Diffuse axonal lesions in childhood].
abstract: OBJECTIVE
  About 48% of all primary traumatic intracranial lesions are represented by so-called Diffuse Axonal Injury (DAI): a pathologic condition characterized by multiple microscopic lesions and hemorrhage at the level of midline cerebral structures, in the subcortical grey matter, and/or within the brainstem. The natural history of DAI is depressing: 100% of the patients deteriorate rapidly to coma and approximately 50% die, while 50% remain in a vegetative state or with severe neurological deficits. In the present report, we describe the results of a study aimed to evaluating the cerebral hemodynamics and the neuroradiological findings observed in four children (6, 8, 10 and 12 years old) affected by DAI.
  
  
  METHODS
  All the patients had been admitted to the Pediatric Intensive Care Unit with Glasgow Coma Score (GCS) of 5. On admission, all patients underwent mechanical ventilation, antiedemigen and barbiturates therapy. Serial CT scan and Transcranial Doppler Sonography (TCD) examinations were carried out in all children. TCD of the middle cerebral arteries was performed through the temporal window. The children underwent insertion of a ventricular catheter for intracranial pressure monitoring. Follow-up time has been, respectively, 4 years, 3 years, 7 and 1 months.
  
  
  RESULTS
  The Glasgow Outcome Score (GOS) of three children is 2 (persistent vegetative state), while the GOS of the one child is 3 (severe neurological deficits).
  
  
  CONCLUSIONS
  DAI results in unfortunate prognosis and large health care costs. The proper medical management of this condition should be based on TCD and SjO2 and CEO2 evaluations, in order to monitor efficaciously the cerebral blood flow.
authors.affiliation: Sezione Autonoma di Terapia Intensiva Pediatrica, Università Cattolica Sacro Cuore di Roma.
authors.forename: A
authors.initials: A
authors.lastname: Chiaretti
authors.forename: M
authors.initials: M
authors.lastname: Visocchi
authors.forename: L
authors.initials: L
authors.lastname: Viola
authors.forename: R
authors.initials: R
authors.lastname: De Benedictis
authors.forename: A
authors.initials: A
authors.lastname: Langer
authors.forename: L
authors.initials: L
authors.lastname: Tortorolo
authors.forename: M
authors.initials: M
authors.lastname: Piastra
authors.forename: G
authors.initials: G
authors.lastname: Polidori
mesh_terms: D000293:Adolescent; D001369:Axons / Q000473:pathology*; D001921:Brain / Q000000981:diagnostic imaging; D001930:Brain Injuries / Q000175:diagnosis / Q000473:pathology; D002648:Child; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial