Diffuse axonal injury in children: clinical correlation with hemorrhagic lesions.
An inception cohort of 40 children and adolescents with traumatic brain injury and suspected diffuse axonal injury were studied using a new high-resolution magnetic resonance imaging susceptibility-weighted technique that is very sensitive for hemorrhage. A blinded comparison was performed between the extent of parenchymal hemorrhage and initial clinical variables as well as outcomes measured at 6 to 12 months after injury. Children with lower Glasgow Coma Scale scores (< or =8, n = 30) or prolonged coma (>4 days, n = 20) had a greater average number (p = 0.007) and volume (p = 0.008) of hemorrhagic lesions. Children with normal outcomes or mild disability (n = 30) at 6 to 12 months had, on average, fewer hemorrhagic lesions (p = 0.003) and lower volume (p = 0.003) of lesions than those who were moderately or severely disabled or in a vegetative state. Significant differences also were observed when comparing regional injury to clinical variables. Because susceptibility-weighted imaging is much more sensitive than conventional T2*-weighted gradient-echo sequences in detecting hemorrhagic diffuse axonal injury, more accurate and objective assessment of injury can be obtained early after insult, and may provide better prognostic information regarding duration of coma as well as long-term outcome.
Tong
Karen A
KA
Department of Radiology, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354, USA. krong@ahs.llumc.edu
Ashwal
Stephen
S
Holshouser
Barbara A
BA
Nickerson
Joshua P
JP
Wall
Christopher J
CJ
Shutter
Lori A
LA
Osterdock
Renatta J
RJ
Haacke
E M
EM
Kido
Daniel
D
D000293:Adolescent; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003128:Coma / Q000209:etiology / Q000473:pathology; D020833:Diffuse Axonal Injury / Q000150:complications* / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D013223:Statistics as Topic; D016896:Treatment Outcome