Pictorial Review of CT and MRI in Pediatric Accidental Traumatic Head Injury

Abstract

Head injuries in children are relatively common leading to a significant number of emergency room visits and hospitalizations annually. Although most injuries are minor, severe brain injury carries a significant mortality rate leading to 3,000 deaths per year in the United States. We describe the pathophysiology of traumatic brain injury in children. Appropriate imaging modalities are discussed with a specific focus on the role of computed tomography (CT) and magnetic resonance imaging (MRI). Classic patterns of injury and associated imaging findings on CT and MRI are described. In addition, characteristic findings seen in birth-related trauma are also reviewed.

Keywords

traumatic brain injury - pediatric - birth injury

• References

• 1 Krug EG, Sharma GK, Lozano R. The global burden of injuries. Am J Public Health 2000; 90 (4) 523-526
• 2 Langlois JA, Rutland-Brown W, Thomas KE. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta. 2006
• 3 Schneier AJ, Shields BJ, Hostetler SG, Xiang H, Smith GA. Incidence of pediatric traumatic brain injury and associated hospital resource utilization in the United States. Pediatrics 2006; 118 (2) 483-492
• 4 White JR, Farukhi Z, Bull C , et al. Predictors of outcome in severely head-injured children. Crit Care Med 2001; 29 (3) 534-540
• 5 Chiaretti A, Piastra M, Pulitanò S , et al. Prognostic factors and outcome of children with severe head injury: an 8-year experience. Childs Nerv Syst 2002; 18 (3–4) 129-136
• 6 Vavilala MS, Bowen A, Lam AM , et al. Blood pressure and outcome after severe pediatric traumatic brain injury. J Trauma 2003; 55 (6) 1039-1044
• 7 Michaud LJ, Rivara FP, Grady MS, Reay DT. Predictors of survival and severity of disability after severe brain injury in children. Neurosurgery 1992; 31 (2) 254-264
• 8 Barkovich AJ. Pediatric Neuroradiology. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2012
• 9 Lee H, Wintermark M, Gean AD, Ghajar J, Manley GT, Mukherjee P. Focal lesions in acute mild traumatic brain injury and neurocognitive outcome: CT versus 3T MRI. J Neurotrauma 2008; 25 (9) 1049-1056
• 10 Zwienenberg M, Muizelaar JP. Severe pediatric head injury: the role of hyperemia revisited. J Neurotrauma 1999; 16 (10) 937-943
• 11 Sharples PM, Stuart AG, Matthews DS, Aynsley-Green A, Eyre JA. Cerebral blood flow and metabolism in children with severe head injury. Part 1: Relation to age, Glasgow coma score, outcome, intracranial pressure, and time after injury. J Neurol Neurosurg Psychiatry 1995; 58 (2) 145-152
• 12 Adelson PD, Clyde B, Kochanek PM, Wisniewski SR, Marion DW, Yonas H. Cerebrovascular response in infants and young children following severe traumatic brain injury: a preliminary report. Pediatr Neurosurg 1997; 26 (4) 200-207
• 13 Ruppel RA, Kochanek PM, Adelson PD , et al. Excitatory amino acid concentrations in ventricular cerebrospinal fluid after severe traumatic brain injury in infants and children: the role of child abuse. J Pediatr 2001; 138 (1) 18-25
• 14 Humphreys RP. Complications of pediatric head injury. Pediatr Neurosurg 1991; -1992 17 (5) 274-278
• 15 Cederberg D, Siesjö P. What has inflammation to do with traumatic brain injury?. Childs Nerv Syst 2010; 26 (2) 221-226
• 16 Edwards MSB, Cogen PH. Craniospinal trauma in children. In: Berg BO, ed. Neurological Aspects of Pediatrics. Boston: Butterworth-Heinemann; 1992: 595-613
• 17 Knopman J, Tsiouris AJ, Souweidane MM. Atraumatic epidural hematoma secondary to a venous sinus thrombosis: a novel finding. J Neurosurg Pediatr 2008; 2 (6) 416-419
• 18 Mohanty A, Kolluri VR, Subbakrishna DK, Satish S, Mouli BA, Das BS. Prognosis of extradural haematomas in children. Pediatr Neurosurg 1995; 23 (2) 57-63
• 19 Adams JH, Doyle D, Ford I, Gennarelli TA, Graham DI, McLellan DR. Diffuse axonal injury in head injury: definition, diagnosis and grading. Histopathology 1989; 15 (1) 49-59
• 20 Brouwer AJ, Groenendaal F, Koopman C, Nievelstein R-J, Han SK, de Vries LS. Intracranial hemorrhage in full-term newborns: a hospital-based cohort study. Neuroradiology 2010; 52 (6) 567-576
• 21 Akiyama Y, Miyata K, Harada K , et al. Susceptibility-weighted magnetic resonance imaging for the detection of cerebral microhemorrhage in patients with traumatic brain injury. Neurol Med Chir (Tokyo) 2009; 49 (3) 97-99 , discussion 99
• 22 Galloway NR, Tong KA, Ashwal S, Oyoyo U, Obenaus A. Diffusion-weighted imaging improves outcome prediction in pediatric traumatic brain injury. J Neurotrauma 2008; 25 (10) 1153-1162
• 23 Eames FA, Waldman JB. CT of posttraumatic intradiploic pseudomeningocele of the skull base: a case report. AJNR Am J Neuroradiol 1991; 12 (5) 985-987
• 24 Tavani F, Zimmerman RA, Clancy RR, Licht DJ, Mahle WT. Incidental intracranial hemorrhage after uncomplicated birth: MRI before and after neonatal heart surgery. Neuroradiology 2003; 45 (4) 253-258
• 25 Rooks VJ, Eaton JP, Ruess L, Petermann GW, Keck-Wherley J, Pedersen RC. Prevalence and evolution of intracranial hemorrhage in asymptomatic term infants. AJNR Am J Neuroradiol 2008; 29 (6) 1082-1089
• 26 Looney CB, Smith JK, Merck LH , et al. Intracranial hemorrhage in asymptomatic neonates: prevalence on MR images and relationship to obstetric and neonatal risk factors. Radiology 2007; 242 (2) 535-541
• 27 Volpe JJ. Neurology of the Newborn, 4th ed. Philadelphia: Saunders; 2001