Neuropathology of inflicted head injury in children I. Patterns of brain damage
Neuropathology of inflicted head injury in children I. Patterns of brain damage
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DOI：
10.1093/brain/124.7.1290
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发表时间：
2001-07-01
期刊：
影响因子：
14.5
通讯作者：
Whitwell, HL
中科院分区：
文献类型：
--
作者：
Geddes, JF;Hackshaw, AK;Whitwell, HL
对53例非意外性儿童颅脑损伤进行了详细的神经病理学研究，包括显微损伤的免疫细胞化学。所有病例的临床详情均可用。有37名婴儿，年龄从20天到9个月不等，16名儿童（年龄从13个月到8岁）。最常见的损伤是颅骨骨折（36%）、急性硬膜下出血（72%）和视网膜出血（71%）;最常见的死亡原因是继发于脑肿胀的颅内压升高（82%）。在显微镜下，77%的病例存在严重的缺氧性脑损伤。53例中有21例发现血管性轴索损伤，而弥漫性创伤性轴索损伤仅见于3例。另外11例，均为婴儿，显示颅颈交界处或颈髓局部轴突损伤的证据。当按头部受伤时的中位年龄分析数据时，出现了与年龄相关的损伤的统计学显著模式。我们的研究表明，2-3个月的婴儿通常有呼吸暂停或其他呼吸异常的病史，在颅颈交界处显示轴突损伤，并且往往也有颅骨骨折，硬膜下出血的薄膜，但没有颅外损伤。1岁以上的儿童更有可能遭受严重的颅外，特别是腹部损伤。他们往往有更大的硬膜下出血，并在创伤性轴索损伤的存在，显示半球白色物质损害的模式更类似于那些在成人报告。摘要弥漫性轴索损伤是一种罕见的儿童头部外伤后遗症。
Fifty-three cases of non-accidental head injury in children were subjected to detailed neuropathological study, which included immunocytochemistry for microscopic damage. Clinical details were available for all the cases. There were 37 infants, age at head injury ranging from 20 days to 9 months, and 16 children (range 13 months to 8 years). The most common injuries were skull fractures (36% of cases), acute subdural bleeding (72%) and retinal haemorrhages (71%); the most usual cause of death was raised intracranial pressure secondary to brain swelling (82%). On microscopy, severe hypoxic brain damage was present in 77% of cases. While vascular axonal damage was found in 21 out of 53 cases, diffuse traumatic axonal injury was present in:only three. Eleven additional cases, all of them infants, showed evidence of localized axonal injury to the craniocervical junction or the cervical cord. When the data were analysed by median age at head injury, statistically significant patterns of age related damage emerged. Our study shows that infants of 2-3 months typically present with a history of apnoea or other breathing abnormalities, show axonal damage at the craniocervical junction, and tend also to have a skull fracture, a thin film of subdural haemorrhage, but lack extracranial injury. Children over 1 year are more likely to suffer severe extracranial, particularly abdominal, injuries. They tend to have larger subdural haemorrhages, and where traumatic axonal injury is present, show patterns of hemispheric white matter damage more akin to those reported in adults. Diffuse axonal injury is an uncommon sequel of inflicted head injury in children.