Radiological Correlates of Raised Intracranial Pressure in Children: A Review

Abstract

Radiological assessment of the head is a routine part of the management of traumatic brain injury. This assessment can help to determine the requirement for invasive intracranial pressure (ICP) monitoring. The radiological correlates of elevated ICP have been widely studied in adults but far fewer specific pediatric studies have been conducted. There is, however, growing evidence that there are important differences in the radiological presentations of elevated ICP between children and adults; a reflection of the anatomical and physiological differences, as well as a difference in the pathophysiology of brain injury in children. Here in, we review the radiological parameters that correspond with increased ICP in children that have been described in the literature. We then describe the future directions of this work and our recommendations in order to develop non-invasive and radiological markers of raised ICP in children.

Presión de perfusión cerebral en pacientes pediátricos con traumatismo craneoencefálico grave.

“…La presencia del "swelling" en la TC de cráneo se ha relacionado con elevación de la PIC en el 75 % de los casos (23). La compresión u obliteración de las cisternas basales se correlaciona con incrementos en la PIC informado por autores como Kouvarellis y otros (24,25), estos autores encontraron en su estudio que la presencia de cisternas basales en la TC en el paciente pediátrico no implica normalización de la PIC, sino que, los valores de la misma se encuentran por debajo de 20 mmHg (25).…”

“…Según Laccarino y colaboradores (28), las desviaciones de la línea media y las compresiones de las cisternas basales constituyeron factores predictivos de los resultados, pero no lo relacionaron con los valores de PPC. En la mayoría de los estudios consultados no se correlacionan los hallazgos tomográficos con el comportamiento de la PPC (22)(23)(24)(25)(26)(27).…”

Measuring intracranial pressure by invasive, less invasive or non-invasive means: limitations and avenues for improvement

“…A review of various radiological measures used to assess raised ICP in children was published recently [182]. One method that has attracted interest is combining MRI images with fluid mechanics to use the measures of blood and CSF volumes that enter and leave the brain during the cardiac cycle to compute a brain elastance metric that allowed for differentiating between elevated and normal ICP [134,183].…”

Mean value of B-mode optic nerve sheath diameter as an indicator of increased intracranial pressure: a systematic review and meta-analysis

“…Although invasive intracranial monitoring has been regarded the “gold-standard”, it demands neurosurgical expertise and is associated with post-procedural complications including infection, hemorrhage, and misplacement [ 4 ]. Signs of elevated ICP could manifest as effacement of ventricles and midline shift on CT and MRI [ 5 ], but these imaging modalities are not always available in all medical environment and require time for transfer. Within the last two decades, evidence has proven ultrasound (US) measurement of the optic nerve sheath diameter (ONSD) to be a surrogate for intracranial pressure, a point-of-care procedure that can be conveniently done at bedside [ 6 , 7 ].…”