Ewing-Cobbs L, Kramer L, Prasad M, Canales D N, Louis P T, Fletcher J M, Vollero H, Landry S H, Cheung K
Department of Pediatrics, University of Texas at Houston Health Science Center, Houston, TX 77030, USA.
Pediatrics. 1998 Aug;102(2 Pt 1):300-7. doi: 10.1542/peds.102.2.300.
To characterize neuroimaging, physical, neurobehavioral, and developmental findings in children with inflicted and noninflicted traumatic brain injury (TBI) and to identify characteristic features of inflicted TBI.
Forty children, 0 to 6 years of age, hospitalized for TBI who had no documented history of previous brain injury were enrolled in a prospective longitudinal study. TBI was categorized as either inflicted (n = 20) or noninflicted (n = 20) based on the assessment of hospital and county protective services. Glasgow Coma Scale scores and neonatal history were comparable in both groups.
Acute computed tomography/magnetic resonance imaging studies and physical findings were evaluated. Glasgow Outcome Scale scores, cognitive development, and motor functioning were assessed an average of 1.3 months after TBI. chi2 analyses assessed differences in the distribution of findings in the inflicted and noninflicted TBI groups.
Signs of preexisting brain injury, including cerebral atrophy, subdural hygroma, and ex vacuo ventriculomegaly, were present in 45% of children with inflicted TBI and in none of the children with noninflicted TBI. Subdural hematomas and seizures occurred significantly more often in children with inflicted TBI. Intraparenchymal hemorrhage, edema, skull fractures, and cephalohematomas were similar in both groups. Retinal hemorrhage was only identified in the inflicted TBI group. Glasgow Outcome Scale scores indicated a significantly less favorable outcome after inflicted than noninflicted TBI. Mental deficiency was present in 45% of the inflicted and 5% of the noninflicted TBI groups.
Characteristic features of inflicted TBI included acute computed tomography/magnetic resonance imaging findings of preexisting brain injury, extraaxial hemorrhages, seizures, retinal hemorrhages, and significantly impaired cognitive function without prolonged impairment of consciousness.
描述遭受创伤性脑损伤（TBI）和非创伤性脑损伤的儿童的神经影像学、体格、神经行为及发育方面的表现，并确定遭受创伤性脑损伤的特征。
40名0至6岁因创伤性脑损伤住院且无既往脑损伤记录史的儿童被纳入一项前瞻性纵向研究。根据医院和县保护服务机构的评估，创伤性脑损伤被分为遭受创伤性（n = 20）或非遭受创伤性（n = 20）。两组的格拉斯哥昏迷量表评分和新生儿病史具有可比性。
评估急性计算机断层扫描/磁共振成像研究结果和体格检查结果。在创伤性脑损伤后平均1.3个月评估格拉斯哥预后量表评分、认知发育和运动功能。采用卡方分析评估遭受创伤性和非遭受创伤性脑损伤组结果分布的差异。
45%遭受创伤性脑损伤的儿童存在既往脑损伤迹象，包括脑萎缩、硬膜下积液和脑外积水性脑室扩大，而非遭受创伤性脑损伤的儿童均无此情况。遭受创伤性脑损伤的儿童硬膜下血肿和癫痫发作明显更常见。两组间脑实质内出血、水肿、颅骨骨折和头皮血肿情况相似。视网膜出血仅在遭受创伤性脑损伤组中发现。格拉斯哥预后量表评分显示，遭受创伤性脑损伤后的预后明显不如非遭受创伤性脑损伤。遭受创伤性脑损伤组中45%存在智力缺陷，非遭受创伤性脑损伤组中为5%。
遭受创伤性脑损伤的特征包括急性计算机断层扫描/磁共振成像显示的既往脑损伤、轴外出血、癫痫发作、视网膜出血，以及认知功能明显受损但意识无长期障碍。
