CT and MR imaging of primary cerebrovascular complications in pediatric head trauma

Abstract

The incidence of severe traumatic head injury in children has constantly increased over the last years. Diagnostic imaging has become an unrenounceable tool for the documentation and follow-up of intracranial lesions. The use of magnetic resonance imaging (MRI) in the early posttraumatic phase has led to a more thorough understanding of intracranial injuries. We retrospectively analyzed the cranial computed tomography (CCT) and magnetic resonance (MR)-studies of patients with traumatic head injuries for primary cerebrovascular complications. In 64 children (45 male, 19 female) with traumatic head injuries, CCT and MR examinations were available for analysis. The children's age ranged from 3 months to 15 years with a median age of 7 years. All patients had initial CCT on admission to the hospital with follow-up examinations depending on clinical state and initial imaging findings. All patients had at least one MR examination between 0 to 120 days after the trauma with a median time interval of 17 days. In five of 64 (7.8%) patients, cerebrovascular complications were found on imaging studies. Initial imaging within the first 24 h after the trauma detected a complete middle cerebral artery infarction in one patient and extensive sinus thrombosis after a complex skull fracture in another. In two patients, thrombosis of the transverse sinus appeared on MRI 4 to 6 days after the trauma. In another patient with open-skull injury, a posttraumatic aneurysm of the pericallosal artery was diagnosed on MRI 30 days after the trauma. Our study shows that, although primary cerebrovascular lesions after traumatic head injuries in children are rare, the radiologist should be aware of the characteristic injury patterns and the time appearance of imaging findings on CT and MRI.

Does Intracranial Venous Thrombosis Cause Subdural Hemorrhage in the Pediatric Population?

“…Complications of severe head trauma-such as sutural diastasis and/or skull fracture with mechanical compression or disruption of the venous sinus, shock, cerebral edema, poor cerebral perfusion, and coagulopathies-are also associated with the development IVT. 8 Our hypothesis is that if extra-axial hemorrhage is the result of IVT, then children with IVT from nontraumatic causes would be at risk to develop subdural collections. Our review of the pediatric literature revealed no previous study that systematically addressed the association of nontraumatic pediatric IVT with convexity SDH in children beyond the neonatal period.…”

Venous injury in abusive head trauma

“…Outside of the perinatal period, predisposing factors include dehydration, an underlying malignancy or chemotherapy (primarily with asparaginase), iron deficiency anemia, infection or sepsis, or thrombophilia from, for example, protein C or protein S deficiency, MTHFR gene mutations or oral contraceptive use [4,31]. Trauma is an important precipitating factor of cortical sinus and venous thrombosis and can be caused by direct trauma (laceration) to a sinus or vein; sinus compression (leading to slowing or cessation of flow) by a depressed skull fracture, adjacent hematoma or cerebral edema or swelling [33]; and intramural hemorrhage caused by rupture of small sinusoids, injury to the endothelial lining, or extension of thrombus from injured emissary veins [34]. Traumatic dural venous sinus thrombosis can be found in 40% of patients with blunt head trauma who had skull fracture extending to a dural venous sinus or jugular bulb [35].…”

Pathophysiology and Treatment of Severe Traumatic Brain Injuries in Children

“…This information is used to determine what neurosurgical interventions are necessary and to provide prognostic information about long-term developmental outcomes (Beauchamp et al, 2011; Suskauer & Huisman, 2009). Cranial CT scans are useful in identifying large hematomas, midline shift, skull fractures, excess CSF accumulation in the ventricles, cerebral edema, and brain herniation (Steinborn et al, 2010; Suskauer & Huisman, 2009). The results of the initial CT scans are used to determine if emergent neurosurgical interventions (e.g., decompression craniotomy) are needed (Suskauer & Huisman, 2009).…”