Twenty-two adults with mild concussions were assessed 5 times during the first 3 months after injury. The initial tests were performed within 72 hours of injury. Each evaluation included a neurological examination and neuropsychological reaction time (RT) tests of simple and choice RT variations. The concussed subjects were compared with control subjects matched for age, sex, and education. The time of day of the testing was equated for the two groups. None of the concussed subjects had a significant neurological deficit and none was hospitalized. There was no significant difference in the number of errors by the two groups on the RT tests. On the simple RT test, requiring a predetermined response to a specific signal, there was no significant difference between the groups, although the concussed group was approximately 28 ms slower on the average than the control group. On the choice RT tests, however, which demand an increased amount of attention and information processing, the concussed subjects were significantly slower than the normal control group, especially during the 1st month after injury. Even after 3 months, the concussed subjects had not yet attained the skill of the control group. Analysis of the response curves over time suggested two processes: an improvement in the concussed group and a slowing in the control group. Within the concussed group, there was no correlation of RT with the severity of the concussion. Even mild concussions can cause significant attentional and information processing impairment in the absence of any apparent neurological problems. Specific neuropsychological tests are necessary to reveal the deficit. A significant impairment seems to last for several weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Review of 70 children presenting with a solitary nontraumatic lump on the head revealed that 61% of the lesions were dermoid tumor, 9% were cephalhematoma deformans, 7% were eosinophilic granuloma, and 4% were occult meningoceles and encephaloceles. Most of the dermoid cysts occurred along sutural lines, but some did not. One of the eosinophilic granulomas was located over the sagittal suture. Seventeen per cent of the "lumps" had significant intracranial extension. An additional 20% of the lumps extended intracranially, but only to the dura mater. Work-up of these lesions should include initial plain skull roentgenograms to assess multiplicity and appropriate computed tomographic scans to assess possible intracranial extension.

Pediatric C-2 fractures have been managed with initial cranial skeletal tong traction or a period of bed rest for reduction and alignment followed by external and/or surgical stabilization. Thirteen children were managed with early halo orthosis to provide the initial reduction/alignment and to accomplish long-term stabilization. Eighty percent had fusion with the halo alone, and 20% went on to fuse after surgery. The average hospitalization for isolated C-2 injury was 10.6 days. Minor complications occurred in 46% of the patients. The literature is reviewed as to the management and outcome of pediatric axis fractures.

A subset of children with minor head injury is known to develop serious neurological consequences, but identifying this subset has been difficult. In adults, multiple variables such as skull fracture, Glasgow Coma Scale score, unconsciousness, and amnesia are significant factors that determine whether to admit the patient to the hospital and the patient’s outcome. As an objective assessment of neurological function, however, the Glasgow Coma Scale has limited usefulness in children, particularly those under 36 months of age. We report our experience with 937 children having head injuries using a Glasgow Coma Scale modified for children (Children’s Coma Scale). During the 6-year study period, 791 of the 937 children (84%) sustained minor head injuries (Glasgow Coma Scale or Children’s Coma Scale score of 13, 14, or 15). The mean age of patients was 5.5 years. Males predominated over females by a 2:1 ratio. The most common cause of injury was a fall, followed by a pedestrian/motor vehicle accident. Seven hundred and thirty-nine of the 791 children were alert at the time of admission. Of these, 99 (13.4%) had lesions requiring surgery: 9 had subdural hematomas, 35 had epidural hematomas, 44 had depressed skull fractures, and 11 had other types of lesions. Two children (0.3%) with Glasgow Coma scores of 13 died after subsequent deterioration, 1 of a delayed epidural hematoma, the other of diffuse cerebral edema. Risk factors such as length of unconsciousness, presence of skull fractures, computed tomography findings, posttraumatic seizure, and Glasgow or Children’s Coma scores were evaluated for their impact on the patient’s outcome. Based on these factors, we have developed guidelines for treating children with minor head injuries.

Object An intracranial ependymoma is a relatively rare but very interesting variety of glioma. In this paper, the authors compiled a review of the pathological features, imaging characteristics, and treatment strategies related to this brain tumor. Methods A Medline search was conducted using the term “ependymoma.” The bibliographies of papers obtained were also checked for articles and chapters that could provide additional understanding of this tumor. Malignant ependy-momas and ependymomas of the spinal cord (including myxopapillary ependymomas) were excluded from this review. Conclusions The posterior fossa is the most frequent site for an intracranial ependymoma. Children are frequently affected. Most authors recommend resecting as much of the tumor as is safely possible. Microscopically, ependymal tumors show both epithelial and glial features. Glial fibrillary acidic protein immunohistochemistry, therefore, helps in identifying ependymomas. Because ependymomas often recur despite surgical intervention, radiotherapy and/or radio-surgery may also play an important role in their treatment. The use of chemotherapy in the treatment of these tumors, especially in the very young, is still being studied.

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Child abuse is a complex sociophysical phenomenon in which a child may suffer physical and mental assault ranging from death to emotional deprivation. In this report, an effort is made to identify the pathogenetic mechanisms of head injury in child abuse and to describe the site of injury, incidence of head injury, and difficulties encountered in establishing a doctor-family relationship. During the years 1970 through 1979,621 children were confirmed victims of child abuse and treated by the medical staff at the Children’s Memorial Hospital in Chicago. Of these, there were 77 children (12%) who suffered associated head injuries ranging from cerebral concussion to irreversible brain damage and/or death. 85% of these head-injured children were under the age of 2 years. 62% were male and 38% female. In analyzing the type of injury which resulted in an associated head injury, we learned that 54% of all injuries were caused by direct blows to the head, face and other parts of the body, 35% were due to dropping, throwing or falling; only 8% were caused by ‘shaking’. 55 injuries (48%) out of 115 trauma cases were thought to be caused by injury to head or face. 53 patients showed 113 external skin wounds such as ecchymoses of eyes, excoriations, bruises, contusion, hematoma, burns, etc. 46% of all external wounds were found over the head and face. This may probably indicate to us that a traumatic force causing injury to the brain is directed to the head and face. The traumatic mechanisms are analyzed and discussed to assess the behavioral derangement of the assault.

Technological advances in neuroradiology and the development of skull base surgery in neurotology have improved diagnosis and management of lesions eroding the tegmen tympani. The diagnosis of brain hernia is to be suspected in patients with a history of complicated chronic ear surgery and a slowly developing pulsatile mass with CSF leak. Patients are best evaluated in the upright position, with an otomicroscope and by magnetic resonance imaging (MRI). Over 6 years, our group has treated seven patients with eight space-occupying lesions eroding the tegmen. Five of the lesions were repaired with a temporalis muscle flap, 2 with fascia and bone, and 1 with Marlex. A review of new technology in the diagnosis of brain hernia and a modification of previous techniques is given.