Management of mild head injury in the pediatric patient

Impact of Early Follow-Up Intervention on Parent-Reported Postconcussion Pediatric Symptoms: A Feasibility Study

OBJECTIVES

To investigate the effectiveness and feasibility of early intervention telephone counseling with parents in limiting postconcussion symptoms and impacts on children and youth.

SETTING

Recruitment occurred postdischarge from one pediatric emergency department.

PARTICIPANTS

Sixty-six parents of children aged 5 to 16 years with a diagnosis of a concussion injury.

DESIGN

A pilot, randomized controlled study compared the efficacy of telephone counseling (reviewing symptom management and return to activity with parents at 1 week and 1 month postinjury) with usual care (no formalized follow-up).

MAIN MEASURES

The Post-Concussion Symptom Inventory and the Family Burden of Injury Interview administered with parents by a blinded therapist at 3 months postinjury.

RESULTS

No significant difference between the groups at 3 months postinjury in postconcussion symptoms (P = .67) and family stress (P = .647).

CONCLUSION

The findings suggest that the early counseling intervention strategy trialed herein may not be effective for children and youth who experience significant postconcussion symptoms. Further research is needed to determine whether more intensive and integrated care would better serve children.

Navigational memory functional magnetic resonance imaging: a test for concussion in children

Concussions are high incidence injuries with potentially devastating consequences. Youths are at risk because of a higher threat of repeated injury, and cumulative effects of concussions exist, making accurate diagnosis and follow-up essential. This study examines a navigational memory functional magnetic resonance imaging (fMRI) task to determine whether activation differences exist between children with concussion and uninjured controls. Fifty adolescents were recruited-35 controls and 15 with concussion. All subjects underwent structural and fMRI testing using our navigational memory task, and a battery of neuropsychological testing. The activation patterns of the 15 subjects with concussion were compared with those of 15 age and sex-matched controls. Subtraction and regression analyses were performed using the matched controls along with scatter-plots using means and 95% quantiles of the 35 controls. While no differences were seen with neuropsychological testing or task performance, subjects with concussion had significantly diminished activation in the retrosplenial, thalamic, and parahippocampal areas bilaterally, along with the right dorsolateral prefrontal cortex and left precuneus. Interestingly, they had increased activation in the left hippocampus and right middle temporal gyrus. Regression analysis demonstrated negative correlations between activation and post-concussive symptoms in the left premotor cortex, superior and inferior parietal lobules, and parahippocampal gyrus. Subjects with concussion show both diminished and increased activation in specific cerebral regions, differentiating them from controls. This is one of the first studies to look at such a task using fMRI and its applicability in testing for concussion in children. These findings support navigational memory fMRI as a potential objective test for concussions.

Voxel-based analysis of diffusion tensor imaging in mild traumatic brain injury in adolescents

BACKGROUND AND PURPOSE

DTI of normal-appearing WM as evaluated by conventional MR imaging in mTBI has the potential to identify important regional abnormalities that relate to PCS. VBA was used to examine WM changes in acute mTBI.

MATERIALS AND METHODS

WM was assessed between 1 and 6 days postinjury with voxel-based DTI analyses in 10 adolescent patients with mTBI and 10 age-matched control participants. In addition to the voxel-based group, analysis used to identify brain pathology across all patients with mTBI, 2 voxel-based linear regressions were performed. These analyses investigated the relation between 1) the ADC and PCS severity scores, and 2) ADC and scores on the BSI of emotional symptoms associated with mTBI. We hypothesized that frontotemporal WM changes would relate to symptoms associated with PCS and endorsed on the BSI.

RESULTS

Patients with mTBI demonstrated significant reductions in ADC in several WM regions and in the left thalamus. As expected, no increases in ADC were found in any region of interest. All injury-affected regions showed decreased radial diffusivity, unchanged AD, and increased FA, which is consistent with axonal cytotoxic edema, reflective of acute injury.

CONCLUSIONS

Whole-brain WM DTI measures can detect abnormalities in acute mTBI associated with PCS symptoms in adolescents.