Postconcussive symptoms in children with mild closed head injuries
Postconcussive symptoms in children with mild closed head injuries
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DOI：
10.1097/00001199-199908000-00003
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发表时间：
1999-08-01
影响因子：
2.4
通讯作者：
Bigler, ED
中科院分区：
文献类型：
--
作者：
Yeates, KO;Luria, J;Bigler, ED
目的：探讨轻度闭合性颅脑损伤(CHI)患儿脑震荡后症状(PCS)的发生率及其与神经心理、行为和神经影像的关系。设计：26名轻度CHI儿童及其8名8名未受伤的兄弟姐妹，年龄在8-15岁，被前瞻性招募，并在基线(即受伤后7天内)和受伤后3个月进行评估。父母对PCS、动机和情感不稳定、行为适应进行评分。基线评分回顾评估了病前的功能，随访评分评估了损伤后的状态。在这两种情况下，儿童都完成了神经心理测试，而轻度CHI的儿童也接受了磁共振成像(MRI)。结果：轻度CHI儿童在病前PCS的基线评分上与兄弟姐妹没有差异，但在伤后3个月的几个PCS上显示出更高的评分。与病前基线评分相比，患有轻度CHI的儿童中有35%的人PCS增加，但兄弟姐妹中没有人这样做。PCS较病前水平升高的轻度CHI儿童在基线时的神经心理功能比PCS没有增加的儿童更差，尽管差异在3个月后部分消失。随着时间的推移，他们的动力也会减弱。他们的行为适应能力较差，MRI上的白质体积较小，但后者的差异在基线时就存在，并且不会随着时间的推移而改变，这表明他们在受伤之前就存在了。结论：在相当大一部分轻度CHI儿童中，创伤后PCS增加，而且比未受伤的兄弟姐妹更常见。轻度CHI后PCS的增加与发病前的神经和心理社会脆弱性有关，但也与损伤后神经心理和神经行为功能的下降有关。
Objective: To examine the incidence and neuropsychological, behavioral, and neuroimaging correlates of postconcussive symptoms (PCS) in children with mild closed head injuries (CHI). Design: 26 Children with mild CHI and 8 of their uninjured siblings, from 8 to 15 years old, were recruited prospectively and assessed at baseline (ie, within 7 days of injury) and at 3 months postinjury. Parents rated PCS, motivation and affective lability, and behavioral adjustment. Baseline ratings assessed premorbid functioning retrospectively, and follow-up ratings assessed postinjury status. On both occasions, children completed neuropsychological testing, and those with mild CHI also underwent magnetic resonance imaging (MRI). Results: Children with mild CHI did not differ from siblings in baseline ratings of premorbid PCS but displayed higher ratings on several PCS at 3 months postinjury. Thirty-five percent of children with mild CHI showed increases in PCS, compared with baseline premorbid ratings, but none of the siblings did so. Children with mild CHI whose PCS increased from premorbid levels showed poorer neuropsychological functioning at baseline than did children whose PCS did not increase, although the differences had partially resolved by 3 months. They also displayed decreased motivation over time. Their behavioral adjustment was poorer and they had smaller white matter volumes on MRI, but the latter differences were present at baseline and did not change over time, suggesting that they existed prior to the injury. Conclusion: Postinjury increases in PCS occur in a sizable minority of children with mild CHI and more often than among uninjured siblings. Increases in PCS following mild CHI are associated with premorbid neurological and psychosocial vulnerability, but also with postinjury decrements in neuropsychological and neurobehavioral functioning.