Koelfen W, Freund M, Dinter D, Schmidt B, Koenig S, Schultze C
Schwerpunkt Neuropädiatrie, Universitätskinderklinik Mannheim, Germany.
Eur J Pediatr. 1997 Mar;156(3):230-5. doi: 10.1007/s004310050590.
The primary issues addressed in this study were: (1) determination of the significance of the classification "good outcome" utilizing the Glasgow Outcome Scale (GOS) in children at least 1 year after brain injury; (2) detection of residual lesions of brain parenchyma in these children upon follow up MRI scans; and (3) detection of relationships between neuropsychological test performance and MRI results. Selection criteria included children 6-15 years of age at the time of testing who received an initial CT scan at the time of their head injury and who had been injured at least 12 months prior to the follow up test. Only children who did not demonstrate neurological disability at the time of follow up examination were selected. The children showed a status of "good outcome" as defined by the GOS. Neurological examination, neuropsychological tests and an MRI were done. The test results of 59 patients were compared to those of a matched control group. Children, after receiving head injuries, showed significantly poorer results with respect to cognitive, motor and fine motor skills. Of all MRI-scans 66% revealed pathological findings. Cortical lesions were detected on MRI in 14% of cases; subcortical injuries were detected in 12% and, deep white matter lesions in 31%. Furthermore, corpus callosum damage was observed in 26% of cases. Pathological MRI findings were also observed in children with mild head injuries. All of the children with normal MRI findings showed abilities comparable to those of children in the control group. Patients with cortical lesions exhibited only motor deficits, whereas motor and cognitive deficits were seen in patients with deep white matter lesions. Children with multiple lesions demonstrated test results in all variables 1 to 2 standard deviations below those of the control group.
Children suffering a brain injury who 1 year later are classified within the "good outcome" group according to the Glasgow Outcome Scale often have significant morphological and functional brain deficits.
本研究探讨的主要问题包括：（1）运用格拉斯哥预后量表（GOS）确定脑损伤至少1年后儿童“良好预后”分类的意义；（2）通过随访MRI扫描检测这些儿童脑实质的残留病变；（3）检测神经心理测试表现与MRI结果之间的关系。入选标准包括测试时年龄在6至15岁、头部受伤时接受过初次CT扫描且在随访测试前至少受伤12个月的儿童。仅选择随访检查时未表现出神经功能障碍的儿童。这些儿童根据GOS被判定为“良好预后”状态。进行了神经学检查、神经心理测试和MRI检查。将59例患者的测试结果与匹配的对照组进行比较。儿童头部受伤后，在认知、运动和精细运动技能方面的表现明显较差。在所有MRI扫描中，66%显示出病理结果。MRI检测到14%的病例有皮质病变；12%有皮质下损伤；31%有深部白质病变。此外，26%的病例观察到胼胝体损伤。轻度头部受伤的儿童也观察到MRI病理结果。所有MRI结果正常的儿童表现出的能力与对照组儿童相当。有皮质病变的患者仅表现出运动缺陷，而深部白质病变的患者则出现运动和认知缺陷。有多处病变的儿童在所有变量上的测试结果比对照组低1至2个标准差。
根据格拉斯哥预后量表在脑损伤1年后被归类为“良好预后”组的儿童，往往存在明显的脑形态和功能缺陷。
