巨头症患儿硬膜下积液的患病率。
Prevalence of subdural collections in children with macrocrania.
作者信息
Greiner M V, Richards T J, Care M M, Leach J L
机构信息
Department of Pediatrics, Mayerson Center for Safe and Healthy Children.
出版信息
AJNR Am J Neuroradiol. 2013 Dec;34(12):2373-8. doi: 10.3174/ajnr.A3588. Epub 2013 Jul 18.
BACKGROUND AND PURPOSE
The relationship between enlarged subarachnoid spaces and subdural collections is poorly understood and creates challenges for clinicians investigating the etiology of subdural collections. The purpose of this study was to determine the prevalence of subdural collections on cross sectional imaging in children with macrocephaly correlating with subarachnoid space enlargement.
MATERIALS AND METHODS
The radiology information system of a large pediatric medical center was reviewed for "macrocrania" and "macrocephaly" on reports of cranial MRI/CT examinations in children <24 months of age, over a 24-month period. Head circumference was obtained from the clinical record. Studies were reviewed blindly for subdural collection presence and subarachnoid space size. Children with prior cranial surgery, parenchymal abnormalities, hydrocephalus, or conditions predisposing to parenchymal volume loss were excluded. Chart review was performed on those with subdural collections.
RESULTS
Imaging from 177 children with enlarged head circumference was reviewed. Nine were excluded, for a final cohort of 168 subjects (108 with enlarged subarachnoid space). Subdural collections were identified in 6 (3.6%), all with enlarged subarachnoid space (6/108, 5.6%). In 4, subdural collections were small, homogeneous, and nonhemorrhagic. In 2, the collections were complex (septations or hemorrhage). Two children were reported as victims of child abuse (both with complex collections). No definitive etiology was established in the other cases.
CONCLUSIONS
The prevalence of subdural collections in imaged children with macrocrania was 3.6%, all occurring in children with enlarged subarachnoid space. Our results suggest that enlarged subarachnoid space can be associated with some subdural collections in this cohort. Despite this, we believe that unexpected subdural collections in children should receive close clinical evaluation for underlying causes, including abusive head trauma.
背景与目的
蛛网膜下腔增宽与硬膜下积液之间的关系尚未完全明确，这给临床医生探究硬膜下积液的病因带来了挑战。本研究的目的是确定在头颅增大且蛛网膜下腔增宽的儿童横断面成像中硬膜下积液的患病率。
材料与方法
回顾了一家大型儿科医疗中心的放射学信息系统，该系统记录了24个月以下儿童在24个月期间的头颅MRI/CT检查报告中的“巨颅症”和“巨头畸形”情况。头围数据取自临床记录。对研究进行盲法评估，以确定是否存在硬膜下积液以及蛛网膜下腔的大小。排除曾接受过颅脑手术、存在脑实质异常、脑积水或有导致脑实质体积减少情况的儿童。对有硬膜下积液的儿童进行病历审查。
结果
对177名头围增大的儿童的影像资料进行了回顾。9名儿童被排除，最终纳入研究队列的有168名受试者（108名蛛网膜下腔增宽）。6名（3.6%）儿童发现有硬膜下积液，所有这些儿童的蛛网膜下腔均增宽（6/108，5.6%）。4名儿童的硬膜下积液较小、均匀且无出血。2名儿童的积液情况较为复杂（有分隔或出血）。有2名儿童被报告为虐待儿童的受害者（均有复杂的积液情况）。其他病例未确定明确病因。
结论
头颅增大的儿童影像检查中硬膜下积液的患病率为3.6%，均发生在蛛网膜下腔增宽的儿童中。我们的结果表明，在该队列中蛛网膜下腔增宽可能与一些硬膜下积液有关。尽管如此，我们认为儿童意外出现的硬膜下积液应接受密切的临床评估，以寻找潜在病因，包括虐待性头部外伤。
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