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Minor head injury


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Minor head injury

  1. 1. MINOR HEAD INJURY & MEDIAL TEMPORAL DAMAGE A PROSPECTIVE CONTROLLED STUDY USING SPECT <ul><ul><li>Deepak Agrawal, Naveen K* </li></ul></ul><ul><ul><li>Departments of Neurosurgery and *Nuclear medicine, All India Institute of Medical Sciences, New Delhi </li></ul></ul>
  2. 2. <ul><li>BACKGROUND </li></ul><ul><li>EXPERIMENTAL EVIDENCE </li></ul><ul><li>Bilateral dentate hilar neuron loss is a consistent finding two weeks after minor head injury and is uniformly associated with memory dysfunction </li></ul>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
  3. 3. <ul><li>WHY MEDIAL TEMPORAL LOBE? </li></ul><ul><li>Hippocampus is especially vulnerable to insults such as ischemia, hypoxia, and seizures </li></ul><ul><li>Extent of hippocampal damage may be correlated with severity of memory impairment </li></ul>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.
  4. 4. <ul><li>AIMS & OBJECTIVES </li></ul><ul><li>Document medial temporal hypoperfusion (MTH) on SPECT in children with minor head injury </li></ul><ul><li>To evaluate MTH on SPECT as a risk factor for development of persistent postconcussion syndrome (PPCS) at three months </li></ul>
  5. 5. <ul><li>MATERIALS AND METHODS </li></ul><ul><li>PROSPECTIVE STUDY </li></ul><ul><li>PERIOD- Nov 2001 TO Oct 2002 </li></ul>
  6. 6. <ul><li>MINOR HEAD INJURY </li></ul><ul><li>Loss of consciousness <30 minutes. </li></ul><ul><li>GCS score 13 to 15. </li></ul><ul><li>Posttraumatic amnesia <24 hours. </li></ul>[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
  7. 7. <ul><li>The Post Concussion Syndrome Checklist score ( PCSC )- via discussion with parent & child </li></ul>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. POSTCONCUSSION SYNDROME 30 children MTH Group (14) Non MTH group (16) PCSC administered Within 72 hrs & At 3 months PCSC administered Within 72 hrs & At 3 months
  8. 8. <ul><ul><ul><ul><ul><li>NCCT head </li></ul></ul></ul></ul></ul>INVESTIGATION <ul><ul><ul><ul><ul><li>Clinical ( PCSC ) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>SPECT scan brain </li></ul></ul></ul></ul></ul><ul><li>(Within 72 hours & at 3 mths of injury ) </li></ul>
  9. 9. <ul><li>STUDY DESIGN </li></ul>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 later Repeat SPECT & clinical evaluation (PCSC) 3 months later Repeat SPECT & clinical evaluation (PCSC)
  10. 10. <ul><li>SPECT scanning was done using 99Tcm-ECD on a dual headed GE 'Varicam' scanner. </li></ul><ul><li>The final data was displayed on a 10 grade color scale and semi quantitative analysis performed. </li></ul>SPECT
  11. 11. <ul><li>Regional cerebral perfusion <10% of contralateral lobe, or in case of bilateral involvement, less than 20% of cerebellum </li></ul>ABNORMAL SPECT SCAN
  12. 12. RESULTS 12 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
  13. 13. RESULTS
  14. 14. RESULTS
  15. 15. <ul><li>ADVANTAGES OF SPECT </li></ul><ul><li>Certain skills are age dependent- Injury in the preschool years seems to affect the process of learning to read. </li></ul><ul><li>SPECT may help in identification and prognostication in this subgroup of children </li></ul>
  16. 16. <ul><li>CONCLUSIONS </li></ul><ul><li>Children with medial temporal hypoperfusion are much more likely to develop memory & learning disorders </li></ul>
  17. 17. <ul><li>CONCLUSIONS </li></ul><ul><li>Ours is the first study of its kind correlating medial temporal hypoperfusion on SPECT with persistent cognitive dysfunction in children </li></ul><ul><li>SPECT-platform for testing the efficacy of various neurobehavioural and pharmacological interventions. </li></ul>
  18. 18. <ul><li>THANK YOU  </li></ul>