Is medial temporal injury responsible for pediatric postconcussion syndrome? A prospective controlled study with single-photon emission computerized tomography

Restricted access

Object

The authors sought to correlate the finding of medial temporal hypoperfusion (MTH) demonstrated on single photon emission computerized tomography (SPECT) with pediatric persistent postconcussion syndrome (PPCS) and to ascertain its usefulness in routine clinical practice.

Methods

Thirty consecutive children with minor head injury and features of PPCS underwent SPECT scanning within 72 hours of injury. Those children having MTH on SPECT were included in the test group (14 patients), and the remaining 16 children comprised the control group. At the end of a 3-month period SPECT scanning was repeated and the incidence of PPCS was assessed clinically in both groups.

Repeated SPECT scanning at 3 months revealed persisting MTH in 13 children (93%) in the test group; no child developed MTH in the control group. Twelve children were found to have PPCS in the MTH group compared with only two in the control group, and this was highly statistically significant (relative risk 6.86 [95% confidence interval 1.84–25.51], p = 0.0003).

Conclusions

There exists significant MTH in pediatric patients with PPCS, which would imply that medial temporal lobe damage (involving the hippocampus and related structures) may occur after minor head injury and could be responsible for the symptoms of PPCS observed in this group of patients. Brain SPECT scans may thus help in the early identification of children prone to develop PPCS, and serial SPECT scanning may serve as a platform for testing the efficacy of various neurobehavioral and pharmacological interventions in these patients.

Article Information

Address reprint requests to: Ashok Kumar Mahapatra, M.Ch., DNB, Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India 110029. email: akmahapatra_22000@yahoo.com.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Chart showing the study design with clinical and SPECT findings in both groups of children. Pts = patients.

  • View in gallery

    Initial (left) and follow-up SPECT studies at 3 months (right) in a child with minor TBI, demonstrating persisting hypoperfusion in the bilateral medial temporal lobes (left more than right) (arrows). Note the improvement in perfusion in the lateral part of the temporal lobe, but none in medial temporal lobe on the follow-up SPECT study.

References

  • 1.

    Agrawal DNaveen KBal CSMahapatra AK: Postconcussion vertigo: is the cause central? Correlation with single photon emission computed tomography. Neurosci Today 7:33362003Agrawal D Naveen K Bal CS Mahapatra AK: Postconcussion vertigo: is the cause central? Correlation with single photon emission computed tomography. Neurosci Today 7:33–36 2003

  • 2.

    Alexander MP: Mild traumatic brain injury: pathophysiology, natural history, and clinical management. Neurology 45:125312601995Alexander MP: Mild traumatic brain injury: pathophysiology natural history and clinical management. Neurology 45:1253–1260 1995

  • 3.

    Arvigo FCossu MFazio BGris APau ARodriguez Get al: Cerebral blood flow in minor cerebral contusion. Surg Neurol 24:2112171985Arvigo F Cossu M Fazio B Gris A Pau A Rodriguez G et al: Cerebral blood flow in minor cerebral contusion. Surg Neurol 24:211–217 1985

  • 4.

    Dikmen SSLevin HS: Methodological issues in the study of mild head injury. J Head Trauma Rehabil 8:30371993Dikmen SS Levin HS: Methodological issues in the study of mild head injury. J Head Trauma Rehabil 8:30–37 1993

  • 5.

    Gross HKling AHenry GHerndon CLavretsky H: Local cerebral glucose metabolism in patients with long-term behavioral and cognitive deficits following mild traumatic brain injury. J Neuropsychiatry Clin Neurosci 8:3243341996Gross H Kling A Henry G Herndon C Lavretsky H: Local cerebral glucose metabolism in patients with long-term behavioral and cognitive deficits following mild traumatic brain injury. J Neuropsychiatry Clin Neurosci 8:324–334 1996

  • 6.

    Hicks RRSmith DHLowenstein DHSaint Marie RMcIntosh TK: Mild experimental brain injury in the rat induces cognitive deficits associated with regional neuronal loss in the hippocampus. J Neurotrauma 10:4054141993Hicks RR Smith DH Lowenstein DH Saint Marie R McIntosh TK: Mild experimental brain injury in the rat induces cognitive deficits associated with regional neuronal loss in the hippocampus. J Neurotrauma 10:405–414 1993

  • 7.

    Hofman PAMStapert SZvan Kroonenburgh MJPGJolles Jde Kruijk JWilmink JT: MR imaging, single-photon emission CT, and neurocognitive performance after mild traumatic brain injury. AJNR Am J Neuroradiol 22:4414492001Hofman PAM Stapert SZ van Kroonenburgh MJPG Jolles J de Kruijk J Wilmink JT: MR imaging single-photon emission CT and neurocognitive performance after mild traumatic brain injury. AJNR Am J Neuroradiol 22:441–449 2001

  • 8.

    Hugenholtz HStuss DTStethem LLRichard MT: How long does it take to recover from a mild concussion? Neurosurgery 22:8538581988Hugenholtz H Stuss DT Stethem LL Richard MT: How long does it take to recover from a mild concussion? Neurosurgery 22:853–858 1988

  • 9.

    Humayun MSPresty SKLafrance NDHolcomb HHLoats HLong DMet al: Local cerebral glucose abnormalities in mild closed head injured patients with cognitive impairments. Nucl Med Commun 10:3353441989Humayun MS Presty SK Lafrance ND Holcomb HH Loats H Long DM et al: Local cerebral glucose abnormalities in mild closed head injured patients with cognitive impairments. Nucl Med Commun 10:335–344 1989

  • 10.

    Jacobs APut EIngels MBossuyt A: Prospective evaluation of technetium-99m-HMPAO SPECT in mild and moderate traumatic brain injury. J Nucl Med 35:9429471994Jacobs A Put E Ingels M Bossuyt A: Prospective evaluation of technetium-99m-HMPAO SPECT in mild and moderate traumatic brain injury. J Nucl Med 35:942–947 1994

  • 11.

    Jenkins LWLu YJohnston WELyeth BGPrough DS: Combined therapy affects outcomes differentially after mild traumatic brain injury and secondary forebrain ischemia in rats. Brain Res 817:1321441999Jenkins LW Lu Y Johnston WE Lyeth BG Prough DS: Combined therapy affects outcomes differentially after mild traumatic brain injury and secondary forebrain ischemia in rats. Brain Res 817:132–144 1999

  • 12.

    Kotapka MJGennarelli TAGraham DIAdams JHThibault LERoss DTet al: Selective vulnerability of hippocampal neurons in acceleration-induced experimental head injury. J Neurotrauma 8:2472581991Kotapka MJ Gennarelli TA Graham DI Adams JH Thibault LE Ross DT et al: Selective vulnerability of hippocampal neurons in acceleration-induced experimental head injury. J Neurotrauma 8:247–258 1991

  • 13.

    Masdeu JCVan Heertum RLKleiman AAnselmi GKissane KHorng Jet al: Early single-photon emission computed tomography in mild head trauma. A controlled study. J Neuroimaging 4:1771811994Masdeu JC Van Heertum RL Kleiman A Anselmi G Kissane K Horng J et al: Early single-photon emission computed tomography in mild head trauma. A controlled study. J Neuroimaging 4:177–181 1994

  • 14.

    Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine: Definition of mild traumatic brain injury. J Head Trauma Rehabil 8:86871993Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine: Definition of mild traumatic brain injury. J Head Trauma Rehabil 8:86–87 1993

  • 15.

    Nakatomi HKuriu TOkabe SYamamoto SHatano OKawahara Net al: Regeneration of hippocampal pyramidal neurons after ischemic brain injury by recruitment of endogenous neural progenitors. Cell 110:4294412002Nakatomi H Kuriu T Okabe S Yamamoto S Hatano O Kawahara N et al: Regeneration of hippocampal pyramidal neurons after ischemic brain injury by recruitment of endogenous neural progenitors. Cell 110:429–441 2002

  • 16.

    Nedd KSfakianakis GGanz WUricchio BVernberg DVillanueva Pet al: 99mTc-HMPAO SPECT of the brain in mild to moderate traumatic brain injury patients: compared with CT—a prospective study. Brain Inj 7:4694791993Nedd K Sfakianakis G Ganz W Uricchio B Vernberg D Villanueva P et al: 99mTc-HMPAO SPECT of the brain in mild to moderate traumatic brain injury patients: compared with CT—a prospective study. Brain Inj 7:469–479 1993

  • 17.

    Rempel-Clower NLZola SMSquire LRAmaral DG: Three cases of enduring memory impairment after bilateral damage limited to the hippocampal formation. J Neurosci 16:523352551996Rempel-Clower NL Zola SM Squire LR Amaral DG: Three cases of enduring memory impairment after bilateral damage limited to the hippocampal formation. J Neurosci 16:5233–5255 1996

  • 18.

    Rutherford WHMerrett JDMcDonald JR: Symptoms at one year following concussion from minor head injuries. Injury 10:2252301979Rutherford WH Merrett JD McDonald JR: Symptoms at one year following concussion from minor head injuries. Injury 10:225–230 1979

  • 19.

    Smith DHLowenstein DHGennarelli TAMcIntosh TK: Persistent memory dysfunction is associated with bilateral hippocampal damage following experimental brain injury. Neurosci Lett 168:1511541994Smith DH Lowenstein DH Gennarelli TA McIntosh TK: Persistent memory dysfunction is associated with bilateral hippocampal damage following experimental brain injury. Neurosci Lett 168:151–154 1994

  • 20.

    Tikofsky RS: Pedicting outcome in traumatic brain injury: what role for rCBF/SPECT? J Nucl Med 35:9479481994Tikofsky RS: Pedicting outcome in traumatic brain injury: what role for rCBF/SPECT? J Nucl Med 35:947–948 1994

  • 21.

    Umile EMSandel MEAlavi ATerry CMPlotkin RC: Dynamic imaging in mild traumatic brain injury: support for the theory of medial temporal vulnerability. Arch Phys Med Rehabil 83:150615132002Umile EM Sandel ME Alavi A Terry CM Plotkin RC: Dynamic imaging in mild traumatic brain injury: support for the theory of medial temporal vulnerability. Arch Phys Med Rehabil 83:1506–1513 2002

  • 22.

    Varney NBushnell DLNathan MKahn DRoberts RRezai Ket al: NeuroSPECT correlates of disabling mild head injury: preliminary findings. J Head Trauma Rehabil 10:18281995Varney N Bushnell DL Nathan M Kahn D Roberts R Rezai K et al: NeuroSPECT correlates of disabling mild head injury: preliminary findings. J Head Trauma Rehabil 10:18–28 1995

  • 23.

    Watson MRFenton GWMcClelland RJLumsden JHeadley MRutherford WH: The post-concussional state: neurophysiological aspects. Br J Psychiatry 167:5145211995Watson MR Fenton GW McClelland RJ Lumsden J Headley M Rutherford WH: The post-concussional state: neurophysiological aspects. Br J Psychiatry 167:514–521 1995

  • 24.

    World Health Organization: International Statistical Classification of Diseases and Related Health Problemsed 10: Geneva, Switzerland: World Health Organization1992World Health Organization: International Statistical Classification of Diseases and Related Health Problems ed 10: Geneva Switzerland: World Health Organization 1992

  • 25.

    Wrightson PMcGinn VGronwall D: Mild head injury in preschool children: evidence that it can be associated with a persisting cognitive defect. J Neurol Neurosurg Psychiatry 59:3753801995Wrightson P McGinn V Gronwall D: Mild head injury in preschool children: evidence that it can be associated with a persisting cognitive defect. J Neurol Neurosurg Psychiatry 59:375–380 1995

  • 26.

    Zola-Morgan SSquire LRAmaral DG: Human amnesia and the medial temporal region: enduring memory impairment following a bilateral lesion limited to field CA1 of the hippocampus. J Neurosci 6:295029671986Zola-Morgan S Squire LR Amaral DG: Human amnesia and the medial temporal region: enduring memory impairment following a bilateral lesion limited to field CA1 of the hippocampus. J Neurosci 6:2950–2967 1986

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 85 85 11
Full Text Views 103 103 0
PDF Downloads 34 34 0
EPUB Downloads 0 0 0

PubMed

Google Scholar