Frontal Lobe Changes after Severe Diffuse Closed Head Injury in Children

Abstract

In view of the pathophysiology and biomechanics of severe closed head injury (CHI) in children, we postulated that the frontal lobes sustain diffuse injury, even in the absence of focal brain lesions detected by magnetic resonance imaging (MRI). This study quantitated the morphological effects of CHI on the frontal lobes in children who sustained head trauma of varying severity. The MRI findings of 14 children who had sustained severe CHIs (Glasgow Coma Scale score of < or = 8) were compared with the findings in a matched group of 14 children having sustained mild head injuries (Glasgow Coma Scale score of 13-15). The patients ranged in age from 5 to 15 years at the time of their MRIs, which were acquired at least 3 months postinjury. MRI findings revealed no focal areas of abnormal signal in the frontal lobes. Volumetric analysis disclosed that the total prefrontal cerebrospinal fluid increased and the gray matter volume decreased in the patients with severe CHI, relative to the mildly injured comparison group. Gray matter volume was also reduced in the orbitofrontal and dorsolateral regions of the brains of children with severe CHI, relative to the children who sustained mild head trauma. These volumetric findings indicate that prefrontal tissue loss occurs after severe CHI in children, even in the absence of focal brain lesions in this area. Nearly two-thirds of the children who sustained severe CHIs were moderately disabled after an average postinjury interval of 3 years or more, whereas 12 of the 14 patients with mild CHIs attained a good recovery (2 were moderately disabled) by the time of study.(ABSTRACT TRUNCATED AT 250 WORDS)

In Vivo Characterization of Traumatic Brain Injury Neuropathology with Structural and Functional Neuroimaging

“…Preliminary findings replicate and extend earlier findings that parenchymal volume loss can be documented and quantified in vivo in patients with TBI even in the absence of large focal lesions (Berryhill et al, 1995). The results are also consistent with recent findings suggesting that DAI affects both gray and white matter to a similar degree when both tissue compartments are systematically assessed.…”

Recovery of Working Memory Following Pediatric Traumatic Brain Injury: A Longitudinal Analysis

“…However, continued improvement was only observed from 12 to 24 months post-injury in the mild and moderate injury groups. Severely injured children’s performances tended to decline during this same period, which may be related to decreased frontal lobe gray matter volume in severely injured children (Berryhill et al, 1995) or to disruption of white matter development as measured by volumetric and diffusion tensor imaging (Ewing-Cobbs et al, 2008; Levin et al, 2000; Levin, Wilde, et al, 2008; Wilde et al, 2005). At 12 months post-injury, rate of change (i.e., slope) did not differ by severity groups.…”

Brain development in rodents and humans: Identifying benchmarks of maturation and vulnerability to injury across species

“…There are reduced volumes in both gray and white matter, particularly within vulnerable regions such as the hippocampus, which are reflected by enlarged ventricular volumes (Berryhill et al, 1995; Wilde et al, 2005). Significant global thinning of cortical gray matter has also been reported amongst older brain-injured children (aged 9–16 years), compared to age-matched typically developing children, which is correlated with deficits in working memory (Merkley et al, 2008).…”