Imagerie des traumatismes crâniens chez l’enfant

The unique features of traumatic brain injury in children. review of the characteristics of the pediatric skull and brain, mechanisms of trauma, patterns of injury, complications, and their imaging findings--part 2

Traumatic brain injury (TBI) is a major cause of morbidity and mortality in children. The unique biomechanical, hemodynamical, and functional characteristics of the developing brain and the age-dependent variance in trauma mechanisms result in a wide range of age specific traumas and patterns of brain injuries. Detailed knowledge of the main primary and secondary pediatric injuries, which enhance sensitivity and specificity of diagnosis, will guide therapy and may give important information about the prognosis. In recent years, anatomical but also functional imaging methods have revolutionized neuroimaging of pediatric TBI. The purpose of this article is (1) to comprehensively review frequent primary and secondary brain injuries and (2) to give a short overview of two special types of pediatric TBI: birth related and nonaccidental injuries.

Indications du scanner cérébral chez les patients présentant un traumatisme crânien bénin

OBJECTIVE

Validate the clinical criteria, which, when absent, would make it safe to bypass CT scan examination in mild cranial injuries.

MATERIAL

and methods. Prospective study including 285 patients with mild cranial injury with a Glasgow score of 15, a normal clinical examination but transitory loss of consciousness or suspected transitory loss of consciousness. The following clinical parameters were systematically reviewed: history of stroke; post-injury headache; post-injury vomiting; alcohol, medication, or drug intoxication; clinical signs of cervico-cranio-facial injury; post-injury convulsions; or coagulation impairment. Systematic CT exploration looked for cranial, encephalic, and facial lesions and individualized the lesions requiring neurosurgical or maxillofacial treatment.

RESULTS

Of the patients studied, 7% presented a cranioencephalic lesion and 7% a facial bone lesion. Neurosurgical intervention was necessary in 0.4% of the patients and maxillofacial surgery in 2.5%. Patients with a positive CT all had at least one clinical risk factor and patients with cranioencephalic lesions had at least two risk factors present. Had patients with no risk factors not been scanned, 15% of the patients would not have had the CT procedure.

CONCLUSION

Selecting CT indications in cases of mild cranial injury with loss of consciousness using a simple and validated evaluation can save 15% of CT procedures without missing any cranial, encephalic, or facial lesions.

Application a la thanatologie de l’imagerie en coupe: revue iconographique

The development of new imaging modalities such as computed tomography and magnetic resonance imaging is a new phenomenon in thanatology. The growing accessibility to these technologies allows, under some conditions, the acquisition of cross-sectional images on cadavers. The authors present a practical pictorial review of post-mortem changes and deadly injuries, illustrating the contributions of modern cross-sectional imaging techniques in thanatology.

[Suspected non-accidental trauma in children: pseudofracture of the parietal bone]

We reported the case of a three month old child who was suspected of abuse syndrome because of a possible parietal bone fracture during radiographic investigation. At autopsy, the parietal bone abnormalities were not fractures, but proved to be unossified membranous strips. A review of the literature about normal variants of parietal suture on roentgenograms was made to avoid the diagnosis of non-accidental trauma in children, especially in live children where autopsy cannot be made.