Prediction of cognitive sequelae based on abnormal computed tomography findings in children following mild traumatic brain injury

2008 ◽  
Vol 1 (6) ◽  
pp. 461-470 ◽  
Author(s):  
Harvey S. Levin ◽  
Gerri Hanten ◽  
Garland Roberson ◽  
Xiaoqi Li ◽  
Linda Ewing-Cobbs ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Working Memory ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Longitudinal Design ◽  
Ct Scans ◽  
Body Regions ◽  
Ct Findings ◽  
Prospective Longitudinal

Object The aim of this study was to determine whether the presence of intracranial pathophysiology on computed tomography (CT) scans obtained within 24 hours of mild traumatic brain injury (MTBI) in children adversely affects neuropsychological outcome during the 1st year postinjury. Methods A prospective longitudinal design was used to examine the neuropsychological outcomes in children (ages 5–15 years) who had been treated for MTBI, which was defined as a loss of consciousness for up to 30 minutes and a lowest Glasgow Coma Scale (GCS) score of 13–15. Exclusion criteria included any preinjury neurological disorder. Outcome assessments were performed within 2 weeks and at 3, 6, and 12 months postinjury. Outcomes were compared between patients with MTBI whose postinjury CT scans revealed complications of brain pathophysiology (32 patients, CMTBI group) and those with MTBI but without complications (48 patients, MTBI group). Results Significant interactions confirmed that the pattern of recovery over 12 months after injury differed depending on the intracranial pathology, presence and severity of injuries to body regions other than the head, preinjury attention-deficit hyperactivity disorder (ADHD), and socioeconomic status. Children in the CMTBI group had significantly poorer episodic memory, slower cognitive processing, diminished recovery in managing cognitive interference, and poorer performance in calculating and reading than patients in the MTBI group. Among the patients with mild or no extracranial injury, visuomotor speed was slower in those in the CMTBI group; and among patients without preinjury ADHD, working memory was worse in those in the CMTBI group. Conclusions Neuropsychological recovery during the 1st year following MTBI is related to the presence of radiographically detectable intracranial pathology. Children with intracranial pathology on acute CT performed more poorly in several cognitive domains when compared with patients whose CT findings were normal or limited to a linear skull fracture. Depending on the presence of preinjury ADHD and concomitant extracranial injury, working memory and visuomotor speed were also diminished in patients whose CT findings revealed complications following MTBI. Computed tomography within 24 hours postinjury appears to be useful for identifying children with an elevated risk for residual neuropsychological changes.

scholarly journals Changes in working memory-related cortical responses following pediatric mild traumatic brain injury: A longitudinal fMRI study

2021 ◽  
Vol 5 ◽  
pp. 205970022110065
Author(s):  
Athena Stein ◽  
Kartik K Iyer ◽  
Aneesh M Khetani ◽  
Karen M Barlow
Keyword(s):  
Traumatic Brain Injury ◽  
Working Memory ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Task Difficulty ◽  
Data Quality Control ◽  
Post Injury ◽  
Cortical Responses ◽  
Prospective Longitudinal ◽  
Over Time

Persistent post-concussion symptoms (PPCS) lasting longer than 4 weeks affect 25% of children with mild traumatic brain injury (mTBI) or concussion. Working memory (WM) problems are a common complaint in children with PPCS. Despite normal function on traditional neuropsychological tests, these children exhibit aberrant cortical responses within the dorsolateral prefrontal cortex (dlPFC) and default mode network (DMN) regions – both of which are implicated in WM. Using a prospective, longitudinal cohort study design, we investigated changes in cortical fMRI responses within the dlPFC and DMN during an nback WM task at two timepoints: one and two months post-injury. Across these timepoints, the primary outcome was change in cortical activations (increase in BOLD) and deactivations (decrease in BOLD) of both dlPFC and DMN. Twenty-nine children (mean age 15.49 ± 2.15; 48.3% male) with fMRI scans at both timepoints were included, following data quality control. Student’s t-tests were used to examine cortical activations across time and task difficulty. ANCOVA F-tests examined cortical responses after removal of baseline across time, task difficulty and recovery. Volumes of interest (5 mm sphere) were placed in peak voxel regions of the DMN and dlPFC to compare cortical responses between recovered and unrecovered participants over time (one-way ANOVA). Between one and two months post-injury, we found significant increases in dlPFC activations and significant activations and deactivations in the DMN with increasing task difficulty, alongside improved task performance. Cortical responses of the DMN and bilateral dlPFC displayed increased intensity in recovered participants, together with improved attention and behavioural symptoms. Overall, our findings suggest evidence of neural compensation and ongoing cognitive recovery from pediatric TBI over time between one and two months post injury in children with PPCS. These results highlight the wider and persisting implications of mTBI in children, whose maturing brains are particularly vulnerable to TBI.

Necessity of repeat head computed tomography (CT) scans in mild traumatic brain injury patients

2014 ◽  
Vol 219 (4) ◽  
pp. e188
Author(s):  
Kaveh N. Najafi ◽  
Geoff Darby ◽  
Jacqueline K. Pham ◽  
Ali Qaderi ◽  
Cristobal Barrios
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Ct Scans ◽  
Head Computed Tomography

Impact of routine S100B protein assay on CT scan use in children with mild traumatic brain injury

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Fleur Lorton ◽  
Jeanne Simon-Pimmel ◽  
Damien Masson ◽  
Elise Launay ◽  
Christèle Gras-Le Guen ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
University Hospital ◽  
S100b Protein ◽  
Research Network ◽  
Ct Scans ◽  
Intermediate Risk ◽  
Protein Assay ◽  
The Impact

AbstractObjectivesTo evaluate the impact of implementing a modified Pediatric Emergency Care Applied Research Network (PECARN) rule including the S100B protein assay for managing mild traumatic brain injury (mTBI) in children.MethodsA before-and-after study was conducted in a paediatric emergency department of a French University Hospital from 2013 to 2015. We retrospectively included all consecutive children aged 4 months to 15 years who presented mTBI and were at intermediate risk for clinically important traumatic brain injury (ciTBI). We compared the proportions of CT scans performed and of in-hospital observations before (2013–2014) and after (2014–2015) implementation of a modified PECARN rule including the S100B protein assay.ResultsWe included 1,062 children with mTBI (median age 4.5 years, sex ratio [F/M] 0.73) who were at intermediate risk for ciTBI: 494 (46.5%) during 2013–2014 and 568 (53.5%) during 2014–2015. During 2014–2015, S100B protein was measured in 451 (79.4%) children within 6 h after mTBI. The proportion of CT scans and in-hospital observations significantly decreased between the two periods, from 14.4 to 9.5% (p=0.02) and 73.9–40.5% (p<0.01), respectively. The number of CT scans performed to identify a single ciTBI was reduced by two-thirds, from 18 to 6 CT scans, between 2013–2014 and 2014–2015. All children with ciTBI were identified by the rules.ConclusionsThe implementation of a modified PECARN rule including the S100B protein assay significantly decreased the proportion of CT scans and in-hospital observations for children with mTBI who were at intermediate risk for ciTBI.

scholarly journals DIAGNOSIS AND MANAGEMENT OF COMPUTED TOMOGRAPHY IN HEAD INJURY

2019 ◽  
Vol 3 (6) ◽  
Author(s):  
Dr. Dileep Kumar Jha ◽  
Dr. Rajnikant Narsinhbhai Chauhan
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Head Trauma ◽  
Severe Head Injury ◽  
Mild Head Injury ◽  
Age Group ◽  
Ct Findings ◽  
Craniocerebral Injuries

Introduction: In human body there are many causes of the injuries. Among all the injuries head injury is also one of the most important injuries which may cause morbidity and mortality. Craniocerebral injuries or Traumatic brain injury (TBI) is defined as any structural skull traumatic injury with alterations of cerebral physiology as a result of an external force either in the form of chemical energy, mechanical energy, electrical energy or thermal heating. Globally craniocerebral injuries or Traumatic brain injury (TBI)is cause of disability in young patients, especially those  <40 years of age. TBI is classified as mild, with most showing adequate and quick recovery. Nevertheless there are some kinds of TBI which showed persistent disabling symptoms that interrupt with their normal daily routine activities. Brain imaging is very important for the patients who suffer traumatic brain injury. In the emergency services Computed tomography (CT) is recommended as first assessment that provides initial information and diagnosis to identify the need of surgery. It also helps in the following of the patient and the evolution of pathology. Many studies suggest that CT can be used to predict patient outcomes. Computed tomography (CT) is an imaging technique which uses as dynamics of injected contrast material, allows rapid quantitative and qualitative evaluation of cerebral perfusion by generating cerebral blood volume (CBV), cerebral blood flow (CBF) and mean transit time (MTT) maps providing clinically important information with stroke subarachnoid hemorrhage (SAH)and head injury. Aim: The main aim of this study is to evaluate the computed tomography findings sustaining head injury and role of computed tomography scan in head injury. Material and Methods: During the study total 90 patients with head injury were included with different age group from 20 to 70 years old. Glasgow coma score (GCS) range 4–15 (mild head injury: GCS >14; moderate head injury: GCS = 9–13; severe head injury GCS <8) were also included in this study. For all the patients with head injury Computed tomography (CT) image were performed with siemen's somatom spirit dual slice spiral CT machine and a protocol of contiguous axial 5-mm sections through the posterior fossa and a contiguous 10 mm axial sequential scans for the rest of the brain and thinner cuts were also taken whenever required. For visualize any fractures of the skull bone algorithms with wide window settings were studied. After initial resuscitation, severity of the cranio-cerebral trauma was graded with the help of Glasgow Coma Scale (GCS) into mild head injury (GCS13- 15), moderate head injury (GCS 9-12) and severe head injury (GCS 3-8). Result: Among total patients sixty five (72.2%) patients were male and twenty five (27.8 %) were female with age range from 20 to 70 years old. In the age group 31-50 year group showed highest frequency of head trauma. The most common causes of head injury were RTA (65.6%) followed by fall injuries (20%) and physical assaults (14.4%). Among patients with head injuries Loss of consciousness and vomiting were the commonest clinical features brought to emergency. Out of 90 cases 59 (65.5%) cases showed mild head injury followed by 14(15.6%) cases sustained moderate head injury and 17(18.9%) had severe head injury. In all types of severity of head injury RTA was the prime etiological factor. Out of total cases 31(34.4%) had normal CT findings and 59(65.6%) had abnormal CT findings. Abnormal CT findings were seen in 59(65.6%) sustaining mild head injury and in all the patients with moderate and severe head injury. Out of 90 cases 13 cases with severe head injury had mortality. The most common mode of injury to cause the mortality was RTA. Five patients with severe head injury also had cervical spine injury Conclusion: This study concludes that use of CT in head trauma can finds high prevalence of head trauma related to CT. Therefore CT should be done when clinically necessary that helps to reduce cost and avoids unnecessary exposure to radiation. Keywords: Head injury, Traumatic brain injury (TBI), computed tomography (CT), Glasgow coma scale (GCS)

Reducing head computed tomography after mild traumatic brain injury: Screening value of clinical findings and S100B protein levels

Brain Injury ◽  
2015 ◽  
Vol 30 (2) ◽  
pp. 172-178 ◽  
Author(s):  
Shadi Asadollahi ◽  
Kamran Heidari ◽  
Mehrdad Taghizadeh ◽  
Arash Mohammad Seidabadi ◽  
Morteza Jamshidian ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Clinical Findings ◽  
S100b Protein ◽  
Protein Levels ◽  
Injury Screening ◽  
Head Computed Tomography

Neutrophil to lymphocyte ratio as a predictive biomarker for computed tomography scan use in mild traumatic brain injury

2020 ◽  
Vol 14 (12) ◽  
pp. 1085-1090
Author(s):  
George A Alexiou ◽  
Georgios D Lianos ◽  
Aggeliki Tzima ◽  
Athanasios Sotiropoulos ◽  
Anastasios Nasios ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Characteristic Curve ◽  
Predictive Biomarker ◽  
Health Concern ◽  
Mild Tbi ◽  
Ct Findings ◽  
The Mean

Aim: Traumatic brain injury (TBI) is a serious health concern. We set out to investigate the role of neutrophil-to-lymphocytes ratio (NLR) at admission for predicting the need for computed tomography (CT) in mild-TBI. Materials & methods: A retrospective study of adult patients who presented with mild-TBI Results: One hundred and thirty patients met the inclusion criteria. Seventy-four patients had positive CT-findings. The mean NLR-levels at presentations were 5.6 ± 4.8. Patients with positive CT-findings had significant higher NLR-levels. Receiver operating characteristic curve analysis was conducted and the threshold of NLR-levels for detecting the cases with positive CT-findings was 2.5, with 78.1% sensitivity and 63% specificity Conclusion: To the best of our knowledge no previous study has assessed the value of NLR-levels for predicting the need for CT in mild-TBI.

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