Social function in children and adolescents after traumatic brain injury: a systematic review 1989 - 2011

Authors: Rosema S, Crowe LM, Anderson V.

Clinical reports and case studies suggest that traumatic brain injury (TBI) can have significant social consequences, with social dysfunction reported as the most debilitating problem for child and adolescent survivors. From a social neuroscience perspective, evidence suggests that social skills are not localised to a specific brain region, but are mediated by an integrated neural network. Many components of this network are susceptible to disruption in the context of TBI. In early development, a brain injury can disrupt this neural network while it is in the process of being established, resulting in social dysfunction. In order to clarify the prevalence and nature of social dysfunction after child TBI, studies of social outcomes in children and adolescents after TBI over the last 23 years have been reviewed. Despite casting a wide net initially, only 28 articles met review criteria. These studies were characterized by methodological weaknesses including variations in definitions of TBI, limited assessment tools, reliance on parent report, small sample sizes, and absent control groups. Despite these limitations,, the weight of evidence confirmed an elevated risk of social impairment in the context of moderate and severe injury. While rarely examined, younger age at insult, pathology to frontal regions and corpus callosum, and social disadvantage and family dysfunction may also increase the likelihood of social difficulties. More research is needed to obtain an accurate picture of social outcomes post brain injury.

Longitudinal changes in cortical thickness in children after traumatic brain injury and their relation to behavioral regulation and emotional control

Authors: Wilde EA, Merkley TL, Bigler ED, Max JE, Schmidt AT, Ayoub KW, McCauley SR, Hunter JV, Hanten G, Li X, Chu ZD, Levin HS.

The purpose of this study was to assess patterns of cortical development over time in children who had sustained traumatic brain injury (TBI) as compared to children with orthopedic injury (OI), and to examine how these patterns related to emotional control and behavioral dysregulation, two common post-TBI symptoms. Cortical thickness was measured at approximately 3 and 18 months post-injury in 20 children aged 8.2-17.5 years who had sustained moderate-to-severe closed head injury and 21 children aged 7.4-16.7 years who had sustained OI. At approximately 3 months post-injury, the TBI group evidenced decreased cortical thickness bilaterally in aspects of the superior frontal, dorsolateral frontal, orbital frontal, and anterior cingulate regions compared to the control cohort, areas of anticipated vulnerability to TBI-induced change. At 18 months post-injury, some of the regions previously evident at 3 months post-injury remained significantly decreased in the TBI group, including bilateral frontal, fusiform, and lingual regions. Additional regions of significant cortical thinning emerged at this time interval (bilateral frontal regions and fusiform gyrus and left parietal regions). However, differences in other regions appeared attenuated (no longer areas of significant cortical thinning) by 18 months post-injury including large bilateral regions of the medial aspects of the frontal lobes and anterior cingulate. Cortical thinning within the OI group was evident over time in dorsolateral frontal and temporal regions bilaterally and aspects of the left medial frontal and precuneus, and right inferior parietal regions. Longitudinal analyses within the TBI group revealed decreases in cortical thickness over time in numerous aspects throughout the right and left cortical surface, but with notable "sparing" of the right and left frontal and temporal poles, the medial aspects of both the frontal lobes, the left fusiform gyrus, and the cingulate bilaterally. An analysis of longitudinal changes in cortical thickness over time (18 months-3 months) in the TBI versus OI group demonstrated regions of relative cortical thinning in the TBI group in bilateral superior parietal and right paracentral regions, but relative cortical thickness increases in aspects of the medial orbital frontal lobes and bilateral cingulate and in the right lateral orbital frontal lobe. Finally, findings from analyses correlating the longitudinal cortical thickness changes in TBI with symptom report on the Emotional Control subscale of the Behavior Rating Inventory of Executive Function (BRIEF) demonstrated a region of significant correlation in the right medial frontal and right anterior cingulate gyrus. A region of significant correlation between the longitudinal cortical thickness changes in the TBI group and symptom report on the Behavioral Regulation Index was also seen in the medial aspect of the left frontal lobe. Longitudinal analyses of cortical thickness highlight an important deviation from the expected pattern of developmental change in children and adolescents with TBI, particularly in the medial frontal lobes, where typical patterns of thinning fail to occur over time. Regions which fail to undergo expected cortical thinning in the medial aspects of the frontal lobes correlate with difficulties in emotional control and behavioral regulation, common problems for youth with TBI. Examination of post-TBI brain development in children may be critical to identification of children that may be at risk for persistent problems with executive functioning deficits and the development of interventions to address these issues.

Renal salt-wasting syndrome in children with intracranial disorders

Authors: Bettinelli A, Longoni L, Tammaro F, Faré PB, Garzoni L, Bianchetti MG.

Hypotonic hyponatremia, a serious and recognized complication of any intracranial disorder, results from extra-cellular fluid volume depletion, inappropriate anti-diuresis or renal salt-wasting. The putative mechanisms by which intracranial disorders might lead to renal salt-wasting are either a disrupted neural input to the kidney or the elaboration of a circulating natriuretic factor. The key to diagnosis of renal salt-wasting lies in the assessment of extra-cellular volume status: the central venous pressure is currently considered the yardstick for measuring fluid volume status in subjects with intracranial disorders and hyponatremia. Approximately 110 cases have been reported so far in subjects ≤18 years of age (male: 63%; female: 37%): intracranial surgery, meningo-encephalitis (most frequently tuberculous) or head injury were the most common underlying disorders. Volume and sodium repletion are the goals of treatment, and this can be performed using some combination of isotonic saline, hypertonic saline, and mineralocorticoids (fludrocortisone). It is worthy of a mention, however, that some authorities contend that cerebral salt wasting syndrome does not exist, since this diagnosis requires evidence of a reduced arterial blood volume, a concept but not a measurable variable.

Optical coherence tomography in diagnosis of intracranial hypertension in children

Authors: Mrugacz M, Szumiński M, Bakunowicz-Łazarczyk A.

Intracranial hypertension (IH) is important cause of optic disc edema. It is essential to distinguish the primary and secondary causes of IH. Persistent increasement of intracranial pressure over 200-250 mmH2O is caused by impairment of the balance between production and absorption of cerebrospinal fluid. Though the exact mechanism of IH is still unknown.
Assessment of usefulness of spectral optical coherence tomography with dual beam eye tracking (SLO/OCT) in diagnosis of intracranial hypertension in children.
4 children (at the age of 3-12 years) with IH underwent an comprehensive ophthalmological examination, including visual acuity testing (Snellen charts), color vision (Ishihara charts), evaluation of anterior and posterior segment of the eye in slit lamp. On SLO/OCT (Spectralis, Heidelberg) scans RNFL profile of the optic disc was assessed at admission day and after 8 weeks of treatment with oral diuretics. In all patients MRI of the central nervous system was performed.
In all children best corrected visual acuity and MRI scans were normal. 3 of 4 patients had secondary IH. Median global RNFL was 273 microm at admission day. In 3 of 4 children remission of optic disc edema was observed after 8 weeks of treatment with diuretics - median global RNFL was 138 microm.
Diagnosis of intracranial hypertension requires interdisciplinary cooperation. SLO/OCT is useful in monitoring remission of the optic disc edema.

Idiopathic intracranial hypertension in children: a review and algorithm

Authors: Standridge SM.

This updated review of pediatric idiopathic intracranial hypertension focuses on epidemiology, clinical presentations, diagnostic criteria, evaluation, clinical course, and treatment. General guidelines for the clinical management of idiopathic intracranial hypertension are discussed. A new algorithm outlines an efficient management strategy for the initial diagnostic evaluation of children with signs or symptoms of intracranial hypertension. This algorithm provides a systematic approach to initial evaluation and management, and identifies important decision-making factors. The risk of permanent visual loss with idiopathic intracranial hypertension necessitates a prompt, thorough collaborative approach in the management of patients. Although idiopathic intracranial hypertension has been recognized for over a century, the need remains for prospectively collected data to promote a better understanding of the etiology, risk factors, evaluative methods, and effective treatments for children with this syndrome.

Mathematical simulation of mild brain injury in children heading soccer balls

Authors: Ponce E, Pérez J, Ponce D, Andresen M.

Background: Heading professional soccer balls can generate mild traumatic brain injury in children. The long-term consequences could include difficulty in solving problems and deficits in memory and language. Aim: To assess the impact of a professional adult soccer ball on a child´s head, using the finite element method and dynamic effects to predict brain damage. Material and Methods: The minimum conditions of an adult game were considered: the ball speed was 6 m/s and the diffuse blow was 345 and 369 Newtons (N), on the forehead and top of the head, respectively. A head was modeled in order to know the stresses, strains and displacements generated by the impacts. The extent of the alteration was determined by comparing the strength of brain tissue, with predictions of computed stresses. The geometric characteristics of the head were transferred from medical images. The input data of the materials of a child´s head was obtained from the literature. Results: In the case of heading with the forehead, mathematical simulation showed frontal lobe alterations, with brain stresses between 0.064 and 0.059 N/mm2. When the heading was with the upper head zone, the brain alterations were in the parietal lobe, with stresses between 0.089 and 0.067 N/mm². In the cerebral spinal fluid the pressure was 3.61 to 3.24 N/mm2. Conclusions: The mathematical simulations reveal evidence of brain alterations caused by a child heading adult soccer balls. The model presented is an economical and quick tool that can help predict brain damage. It demonstrates the ability of the cerebral spinal fluid (CSF) to absorb shock loads.


Subscribe to RSS - Children