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.

Background

Minor head injuries usually cause no severe complications. The impact on the skull causes an opposite movement of the brain parenchyma, with stretching of the vessels because of the high moment of inertia. This leads to a traumatic endothelial intimal lesion, followed by fibrin accumulation and the formation of a white thrombus occluding the lumen [1].

Objectives

To detect lenticulostriate arteries pathology in children with basal ganglia stroke.

To compare sensitivity and specificity of MRI ant MDCT in identifying ischemic lesions.

Methods

CT and MRI of 31 pediatric patients with acute basal ganglia stroke were retrospectively evaluated. All patients had hemiparesis and underwent a comprehensive examination including CT, MRI and MRA. The control group consisted of 15 children without diagnostic findings. Student's t-test was used.

Results

Ischemic lesions were visualized in 31 patients using MRI and in 18 patient using CT. MRI sensitivity and specificity were 100% and 100%. CT sensitivity and specificity were 58% and 94%. Linear areas of hyperdensity in region of lenticulostriate arteries passage were detected in 22 patients and in 1 control group child. A statistically significant difference (p<0,05) was observed between measurements of mean density in group of patients (62,9±6,55 (p<0,5)) and control group (34,6±6,1 (p<0,5).

Conclusion

Linear areas of hyperdensity in region of lenticulostriate arteries passage in patients with acute basal ganglia stroke were regarded as blood clots that can play a major role in pathogenesis of basal ganglia stroke. MRI sensitivity in identifying ischemic lesions is twice as large as MDCT.

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.

Background

Minor head injuries usually cause no severe complications. The impact on the skull causes an opposite movement of the brain parenchyma, with stretching of the vessels because of the high moment of inertia. This leads to a traumatic endothelial intimal lesion, followed by fibrin accumulation and the formation of a white thrombus occluding the lumen [1].

Objectives

To detect lenticulostriate arteries pathology in children with basal ganglia stroke.

To compare sensitivity and specificity of MRI ant MDCT in identifying ischemic lesions.

Methods

CT and MRI of 31 pediatric patients with acute basal ganglia stroke were retrospectively evaluated. All patients had hemiparesis and underwent a comprehensive examination including CT, MRI and MRA. The control group consisted of 15 children without diagnostic findings. Student's t-test was used.

Results

Ischemic lesions were visualized in 31 patients using MRI and in 18 patient using CT. MRI sensitivity and specificity were 100% and 100%. CT sensitivity and specificity were 58% and 94%. Linear areas of hyperdensity in region of lenticulostriate arteries passage were detected in 22 patients and in 1 control group child. A statistically significant difference (p<0,05) was observed between measurements of mean density in group of patients (62,9±6,55 (p<0,5)) and control group (34,6±6,1 (p<0,5).

Conclusion

Linear areas of hyperdensity in region of lenticulostriate arteries passage in patients with acute basal ganglia stroke were regarded as blood clots that can play a major role in pathogenesis of basal ganglia stroke. MRI sensitivity in identifying ischemic lesions is twice as large as MDCT.