RISK EVALUATION OF MALIGNANT INTRACRANIAL HYPERTENSION DEVELOPMENT IN CHILDREN WITH SEVERE TRAUMATIC BRAIN INJURY
- Mariia Akhlebinina, Russian Federation
- Ilia Melnikov, Russian Federation
- Tolibdzhon Akhadov, United States of America
- Mariia Akhlebinina, Russian Federation
- Maxim Ublinskiy, Russian Federation
Abstract
Background
Brain swelling is one of the most dangerous complications of primary traumatic brain injury (TBI), which leads to rise of intracranial pressure (ICP). We propose that DWI can be a useful tool for evaluating the risk of malignant intracranial hypertension development and can be used to determine the need of decompressive craniectomy in patients with severe TBI.
Objectives
To determine the potential of DWI in assessing the risk of developing malignant intracranial hypertension in children with severe TBI.
Methods
We retrospectively evaluated clinical and MRI data of 36 pediatric patients with severe TBI. The severity of clinical condition of each patient was evaluated with the use of the Glasgow Coma Scale (GCS). Parenchymal ICP gauge placement was performed in all patients for adequate ICP monitoring. Patients were categorized into three groups: (1) high ICP managed conservatively; (2) malignant ICP managed with DC; (3) normal ICP. Four pairs of symmetrical ROIs were manually drawn on ADC maps. All ROIs excluded areas that appeared abnormal on T2WI.
Results
Average ADC values in the deep white matter of frontal lobes were significantly increased in children with severe TBI with following DC (851.5+/-54.3x10-3 mm2/sec) compared to those with severe TBI and conservatively controlled ICP (756.4+/-40.5x10-3 mm2/sec; p<0.05).
Conclusion
Assessment of DWI values in severe pediatric TBI is a potential tool for evaluating the risk of malignant ICP development. Early identification of children at high risk for this complication may assist in earlier aggressive clinical management of pediatric TBI patients.