View
459
Download
1
Embed Size (px)
Citation preview
MINORMINOR HEAD INJURY & HEAD INJURY & MEDIAL TEMPORAL DAMAGEMEDIAL TEMPORAL DAMAGE
A PROSPECTIVE CONTROLLED A PROSPECTIVE CONTROLLED STUDY USING SPECTSTUDY USING SPECT
Deepak Agrawal, Naveen K*Departments of Neurosurgery and *Nuclear medicine, All India Institute of Medical
Sciences, New Delhi
BACKGROUNDBACKGROUND
EXPERIMENTAL EVIDENCEEXPERIMENTAL EVIDENCEBilateral dentate hilar neuron loss is a Bilateral dentate hilar neuron loss is a consistent finding two weeks after consistent finding two weeks after minor head injury and is uniformly minor head injury and is uniformly associated with memory dysfunctionassociated with memory dysfunction
Smith DH, Lowenstein DH, Gennarelli DI, McIntosh TK. Persistent memory dysfunction is associated with bilateral hippocampal damage following experimental brain injury. Neurosci Lett 1994;168:151-154
WHY MEDIAL TEMPORAL LOBE?
•Hippocampus is especially vulnerable to insults such as ischemia, hypoxia, and seizures
•Extent of hippocampal damage may be correlated with severity of memory impairment
Rempel-Clower NL, Zola SM, Squire LR, Amaral DG. Three cases of enduring memory impairment after bilateral damage limited to the hippocampal formation. J Neurosci 1996;16:5233-5255.
AIMS & OBJECTIVESAIMS & OBJECTIVES Document medial temporal Document medial temporal
hypoperfusion (MTH) on SPECT in hypoperfusion (MTH) on SPECT in children with minor head injurychildren with minor head injury
To evaluate MTH on SPECT as a risk To evaluate MTH on SPECT as a risk factor for development of factor for development of persistent persistent postconcussion syndrome (PPCS) at postconcussion syndrome (PPCS) at three months three months
MATERIALS AND METHODSMATERIALS AND METHODS
PROSPECTIVE STUDYPROSPECTIVE STUDY
PERIOD- Nov 2001 TO Oct 2002 PERIOD- Nov 2001 TO Oct 2002
MINOR HEAD INJURY Loss of consciousness <30 minutes. GCS score 13 to 15. Posttraumatic amnesia <24 hours.
[criteria published by the members of the Mild Traumatic brain injury Interdisciplinary Special Interest Group (BISIG)]
Kay T, Harrington DE, et al. Definition of mild traumatic brain injury. J Head Trauma Rehabil 1993;8:86
The Post Concussion The Post Concussion Syndrome Checklist Syndrome Checklist score (score (PCSCPCSC)- via )- via discussion with discussion with parent & childparent & child
Gouvier WD, Cubic B, Jones G, Brantly P, Cutlip Q. Postconcussion symptoms and daily stress in normal and head-injured college populations. Arch Clin Neuropsychol 1992;7:193-211.
30 children
MTH Group (14) Non MTH group (16)
PCSC administeredWithin 72 hrs& At 3 months
PCSC administeredWithin 72 hrs& At 3 months
POSTCONCUSSION SYNDROMEPOSTCONCUSSION SYNDROME
NCCT headNCCT head
INVESTIGATIONINVESTIGATION
Clinical (Clinical (PCSCPCSC))
SPECT scan brainSPECT scan brain(Within 72 hours & at 3 mths of (Within 72 hours & at 3 mths of injuryinjury ) )
30 Children with minor head injury
SPECT scan & PCSC administration(within 72 hrs)
Medial temporal hypoperfusion(14 children)
No Medial temporal hypoperfusion(16 children)
3 months laterRepeat SPECT & clinical evaluation
(PCSC)
3 months laterRepeat SPECT & clinical evaluation
(PCSC)
STUDY DESIGNSTUDY DESIGN
SPECT scanning was done using 99Tcm-SPECT scanning was done using 99Tcm-ECD on a dual headed GE 'Varicam' ECD on a dual headed GE 'Varicam' scanner.scanner.
The final data was displayed on a 10 The final data was displayed on a 10 grade color scale and semi quantitative grade color scale and semi quantitative analysis performed. analysis performed.
SPECTSPECT
Regional cerebral perfusion <10% of Regional cerebral perfusion <10% of contralateral lobe, or in case of bilateral contralateral lobe, or in case of bilateral involvement, less than 20% of cerebelluminvolvement, less than 20% of cerebellum
ABNORMAL SPECT SCANABNORMAL SPECT SCAN
RESULTS12 children were found to have cognitive dysfunction in the MTH group compared to only two in the control group
Relative risk (95% CI)= 6.86(1.84-25.51). P=0.0003
MTH group Control group
RESULTS
RESULTS
ADVANTAGES OF SPECTADVANTAGES OF SPECT Certain skills are age dependent-Certain skills are age dependent-
Injury in the preschool years seems Injury in the preschool years seems to affect the process of learning to to affect the process of learning to read.read.
•SPECT may help in identification and SPECT may help in identification and prognostication in this subgroup of prognostication in this subgroup of childrenchildren
CONCLUSIONSCONCLUSIONS
Children with Children with medial temporal medial temporal hypoperfusionhypoperfusion are much more likely to are much more likely to develop memory & learning disordersdevelop memory & learning disorders
CONCLUSIONSCONCLUSIONS Ours is the first study of its kind Ours is the first study of its kind
correlating correlating medial temporal medial temporal hypoperfusionhypoperfusion on SPECT with persistent on SPECT with persistent cognitive dysfunction in childrencognitive dysfunction in children
SPECT-platform for testing the SPECT-platform for testing the efficacy of various neurobehavioural efficacy of various neurobehavioural and pharmacological interventions.and pharmacological interventions.
THANK THANK YOUYOU