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Child's Nervous System

Published in:

01-02-2017 | Original Paper

Early diffusion restriction of white matter in infants with small subdural hematomas is associated with delayed atrophy

Authors: Cameron A. Elliott, Vijay Ramaswamy, Francois D Jacob, Tejas Sankar, Vivek Mehta

Published in: Child's Nervous System | Issue 2/2017

Abstract

Background

Traumatic brain injury (TBI) is a major cause of infant morbidity and mortality. In these patients, magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) is the test of choice to describe the extent of microstructural injury.

Case presentation and discussion

In this case series, we describe novel acute and chronic MRI findings in four infants (6–19 months) with small, unilateral subdural hematomas in whom the etiology of head injury was suspicious for non-accidental trauma (NAT). Acute (<1-week post-injury) DWI revealed extensive areas of restricted diffusion isolated to the cerebral white matter predominantly ipsilateral to the subdural hematoma. After prolonged pediatric intensive care treatment including subdural evacuation (n = 2) or decompressive craniectomy (n = 1), all patients survived albeit with significant motor and cognitive deficits. Delayed structural MRI (6–9-year post-injury) demonstrated cortical and subcortical atrophy well-correlated with areas of acute restricted diffusion.

Conclusion

These four cases highlight that relatively small subdural hematomas can be associated with extensive white matter injury—detectable only by early DWI—which have long-term structural and functional consequences.

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Title: Early diffusion restriction of white matter in infants with small subdural hematomas is associated with delayed atrophy
Authors: Cameron A. Elliott
Vijay Ramaswamy
Francois D Jacob
Tejas Sankar
Vivek Mehta
Publication date: 01-02-2017
Publisher: Springer Berlin Heidelberg
Published in: Child's Nervous System / Issue 2/2017
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-016-3271-3

At a glance: The STEP trials

Springer Medicine

Early diffusion restriction of white matter in infants with small subdural hematomas is associated with delayed atrophy

Abstract

Background

Case presentation and discussion

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Case presentation and discussion

Conclusion

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