Children

The Optic Disc Is Minimal in Children With Idiopathic Intracranial Hypertension

Authors: Dai S, Trimboli C, Buncic JR.

This study sought to characterize the optic disc morphology, particularly the cup-to-disc ratio of the optic nerve head in children with idiopathic intracranial hypertension. The medical charts and digital optic disc photos of children with confirmed diagnosis of idiopathic intracranial hypertension were reviewed retrospectively. The optic disc area, cup area, and cup-to-disc ratio were measured digitally using VISUPAC software, and the mean values of those parameters were compared to the published norms. Of children with idiopathic intracranial hypertension, 83% had absence of the physiological cup of the optic disc, compared to 10% of children in the general population of the same age. The median disc area was 2.2 mm(2), and median cup area was 0.0mm(2), compared to the published norms of 2.69 mm(2) and 0.44 mm(2), respectively. There is very significantly high prevalence of small optic disc cups in children with idiopathic intracranial hypertension, with the cup being absent on majority of cases in our patient cohort. This may signal an underlying systemic predisposition to the development of intracranial hypertension.

Incidence of Disability Among Children 12 Months After Traumatic Brain Injury

Authors: Rivara FP, Koepsell TD, Wang J, Temkin N, Dorsch A, Vavilala MS, Durbin D, Jaffe KM.

Objectives. We examined the burden of disability resulting from traumatic brain injuries (TBIs) among children younger than 18 years. Methods. We derived our data from a cohort study of children residing in King County, Washington, who were treated in an emergency department for a TBI or for an arm injury during 2007-2008. Disabilities 12 months after injury were assessed according to need for specialized educational and community-based services and scores on standardized measures of adaptive functioning and social-community participation. Results. The incidence of children receiving new services at 12 months was about 10-fold higher among those with a mild TBI than among those with a moderate or severe TBI. The population incidence of disability (defined according to scores below the norm means on the outcome measures included) was also consistently much larger (2.8-fold to 28-fold) for mild TBIs than for severe TBIs. Conclusions. The burden of disability caused by TBIs among children is primarily accounted for by mild injuries. Efforts to prevent these injuries as well as to decrease levels of disability following TBIs are warranted. (Am J Public Health. Published online ahead of print September 20, 2012: e1-e6. doi:10.2105/AJPH.2012.300696).

Timing of Traumatic Brain Injury in Childhood and Intellectual Outcome

Authors: Crowe LM, Catroppa C, Babl FE, Rosenfeld JV, Anderson V.

OBJECTIVE: Typically, studies on outcomes after traumatic brain injury (TBI) have investigated whether a younger age at injury is associated with poorer recovery by comparing 2 age groups rather than participants injured across childhood. This study extended previous research by examining whether the influence of age on recovery fits an early vulnerability or critical developmental periods model.
METHODS: Children with a TBI (n = 181) were categorized into 4 age-at-injury groups-infant, preschool, middle childhood, and late childhood-and were evaluated at least 2-years post-TBI on IQ.
RESULTS: Overall, the middle childhood group had lower IQ scores across all domains. Infant and preschool groups performed below the late childhood group on nonverbal and processing speed domains.
CONCLUSIONS: Contrary to expectations, children injured in middle childhood demonstrated the poorest outcomes; this age potentially coincides with a critical period of brain and cognitive development.

Emergency management of increased intracranial pressure

Authors: Pitfield AF, Carroll AB, Kissoon N.

Primary neurological injury in children can be induced by diverse intrinsic and extrinsic factors including brain trauma, tumors, and intracranial infections. Regardless of etiology, increased intracranial pressure (ICP) as a result of the primary injury or delays in treatment may lead to secondary (preventable) brain injury. Therefore, early diagnosis and aggressive treatment of increased ICP is vital in preventing or limiting secondary brain injury in children with a neurological insult. Present management strategies to improve survival and neurological outcome focus on reducing ICP while optimizing cerebral perfusion and meeting cerebral metabolic demands. Targeted therapies for increased ICP must be considered and implemented as early as possible during and after the initial stabilization of the child. Thus, the emergency physician has a critical role to play in early identification and treatment of increased ICP. This article intends to identify those patients at risk of intracranial hypertension and present a framework for the emergency department investigation and treatment, in keeping with contemporary guidelines. Intensive care management and the treatment of refractory increases in ICP are also outlined.

The Unique Features of Traumatic Brain Injury in Children. Review of the Characteristics of the Pediatric Skull and Brain, Mechanisms of Trauma, Patterns of Injury, Complications and Their Imaging Findings-Part 1

Authors: Pinto PS, Poretti A, Meoded A, Tekes A, Huisman TA.

Traumatic head/brain injury (TBI) is a leading cause of death and life-long disability in children. The biomechanical properties of the child's brain and skull, the size of the child, the age-specific activity pattern, and higher degree of brain plasticity result in a unique distribution, degree, and quality of TBI compared to adult TBI. A detailed knowledge about the various types of primary and secondary pediatric head injuries is essential to better identify and understand pediatric TBI. The goals of this review article are (1) to discuss the unique epidemiology, mechanisms, and characteristics of TBI in children, and (2) to review the anatomical and functional imaging techniques that can be used to study common and rare pediatric traumatic brain injuries and their complications. J Neuroimaging 2012;XX:1-17.

The Unique Features of Traumatic Brain Injury in Children. Review of the Characteristics of the Pediatric Skull and Brain, Mechanisms of Trauma, Patterns of Injury, Complications, and their Imaging Findings-Part 2

Authors: Pinto PS, Meoded A, Poretti A, Tekes A, Huisman TA.

Traumatic brain injury (TBI) is a major cause of morbidity and mortality in children. The unique biomechanical, hemodynamical, and functional characteristics of the developing brain and the age-dependent variance in trauma mechanisms result in a wide range of age specific traumas and patterns of brain injuries. Detailed knowledge of the main primary and secondary pediatric injuries, which enhance sensitivity and specificity of diagnosis, will guide therapy and may give important information about the prognosis. In recent years, anatomical but also functional imaging methods have revolutionized neuroimaging of pediatric TBI. The purpose of this article is (1) to comprehensively review frequent primary and secondary brain injuries and (2) to give a short overview of two special types of pediatric TBI: birth related and nonaccidental injuries. J Neuroimaging 2012;XX:1-24.

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