MINOR HEAD INJURY

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MINOR HEAD INJURY MEDIAL TEMPORAL DAMAGE

• A PROSPECTIVE CONTROLLED STUDY USING SPECT

Deepak Agrawal, Naveen K, C S Bal, A K
Mahapatra Departments of Neurosurgery and
Nuclear medicine, All India Institute of Medical
Sciences, New Delhi
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• BACKGROUND
• EXPERIMENTAL EVIDENCE
• Bilateral dentate hilar neuron loss is a
  consistent finding two weeks after minor head
  injury and is uniformly associated 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
1994168151-154
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• 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 1996165233-5255.
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• AIMS OBJECTIVES
• Document medial temporal hypoperfusion (MTH) on
  SPECT in children with minor head injury
• To evaluate MTH on SPECT as a risk factor for
  development of persistent postconcussion syndrome
  (PPCS) at three months

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• MATERIALS AND METHODS
• PROSPECTIVE STUDY
• PERIOD- Nov 2001 TO Oct 2002

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• MINOR HEAD INJURY
• Loss of consciousness lt30 minutes.
• GCS score 13 to 15.
• Posttraumatic amnesia lt24 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 1993886
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• POSTCONCUSSION SYNDROME

• The Post Concussion Syndrome Checklist score
  (PCSC)- via discussion with parent 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 19927193-211.
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INVESTIGATION

• NCCT head

• Clinical (PCSC)
• SPECT scan brain
• (Within 72 hours at 3 mths of injury )

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• STUDY DESIGN

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SPECT

• SPECT scanning was done using 99Tcm-ECD on a dual
  headed GE 'Varicam' scanner.
• The final data was displayed on a 10 grade color
  scale and semi quantitative analysis performed.

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ABNORMAL SPECT SCAN

• Regional cerebral perfusion lt10 of
  contralateral lobe, or in case of bilateral
  involvement, less than 20 of cerebellum

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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). P0.0003
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RESULTS
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RESULTS
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• ADVANTAGES OF SPECT
• Certain skills are age dependent- Injury in the
  preschool years seems to affect the process of
  learning to read.

• SPECT may help in identification and
  prognostication in this subgroup of children

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• CONCLUSIONS
• Children with medial temporal hypoperfusion are
  much more likely to develop memory learning
  disorders

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• CONCLUSIONS
• Ours is the first study of its kind correlating
  medial temporal hypoperfusion on SPECT with
  persistent cognitive dysfunction in children
• SPECT-platform for testing the efficacy of
  various neurobehavioural and pharmacological
  interventions.

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• THANK YOU ?