Frontal lobe changes after severe diffuse closed head injury in children: A volumetric study of magnetic resonance imaging

P. Berryhill, M. A. Lilly, H. S. Levin, G. R. Hillman, D. Mendelsohn, D. G. Brunder, J. M. Fletcher, J. Kufera, T. A. Kent, J. Yeakley, D. Bruce, H. M. Eisenberg, J. G. McComb, H. L. Rekate

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

IN VIEW OF the pathophysiology and biomechanics of severe closed head injury (CHI) in children, we postulated that the frontal lobes sustain diffuse injury, even in the absence of focal brain lesions detected by magnetic resonance imaging (MRI). This study quantitated the morphological effects of CHI on the frontal lobes in children who sustained head trauma of varying severity. The MRI findings of 14 children who had sustained severe CHIs (Glasgow Coma Scale score of ≤8) were compared with the findings in a matched group of 14 children having sustained mild head injuries (Glasgow Coma Scale score of 13-15). The patients ranged in age from 5 to 15 years at the time of their MRIs, which were acquired at least 3 months postinjury. MRI findings revealed no focal areas of abnormal signal in the frontal lobes. Volumetric analysis disclosed that the total prefrontal cerebrospinal fluid increased and the gray matter volume decreased in the patients with severe CHI, relative to the mildly injured comparison group. Gray matter volume was also reduced in the orbitofrontal and dorsolateral regions of the brains of children with severe CHI, relative to the children who sustained mild head trauma. These volumetric findings indicate that prefrontal tissue loss occurs after severe CHI in children, even in the absence of focal brain lesions in this area. Nearly two-thirds of the children who sustained severe CHIs were moderately disabled after an average postinjury interval of 3 years or more, whereas 12 of the 14 patients with mild CHIs attained a good recovery (2 were moderately disabled) by the time of study. Although this initial study of brain morphometry after CHI in children was not designed to isolate the contribution of frontal lobe damage to residual disability, further research involving a larger sample is in progress to address this issue.

Original languageEnglish (US)
Pages (from-to)392-400
Number of pages9
JournalNeurosurgery
Volume37
Issue number3
StatePublished - 1995

Fingerprint

Closed Head Injuries
Frontal Lobe
Magnetic Resonance Imaging
Craniocerebral Trauma
Glasgow Coma Scale
Brain
Time and Motion Studies
Prefrontal Cortex
Biomechanical Phenomena
Cerebrospinal Fluid
Research Design

Keywords

  • Children
  • Closed head injury
  • Magnetic resonance imaging

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Berryhill, P., Lilly, M. A., Levin, H. S., Hillman, G. R., Mendelsohn, D., Brunder, D. G., ... Rekate, H. L. (1995). Frontal lobe changes after severe diffuse closed head injury in children: A volumetric study of magnetic resonance imaging. Neurosurgery, 37(3), 392-400.

Frontal lobe changes after severe diffuse closed head injury in children : A volumetric study of magnetic resonance imaging. / Berryhill, P.; Lilly, M. A.; Levin, H. S.; Hillman, G. R.; Mendelsohn, D.; Brunder, D. G.; Fletcher, J. M.; Kufera, J.; Kent, T. A.; Yeakley, J.; Bruce, D.; Eisenberg, H. M.; McComb, J. G.; Rekate, H. L.

In: Neurosurgery, Vol. 37, No. 3, 1995, p. 392-400.

Research output: Contribution to journalArticle

Berryhill, P, Lilly, MA, Levin, HS, Hillman, GR, Mendelsohn, D, Brunder, DG, Fletcher, JM, Kufera, J, Kent, TA, Yeakley, J, Bruce, D, Eisenberg, HM, McComb, JG & Rekate, HL 1995, 'Frontal lobe changes after severe diffuse closed head injury in children: A volumetric study of magnetic resonance imaging', Neurosurgery, vol. 37, no. 3, pp. 392-400.
Berryhill, P. ; Lilly, M. A. ; Levin, H. S. ; Hillman, G. R. ; Mendelsohn, D. ; Brunder, D. G. ; Fletcher, J. M. ; Kufera, J. ; Kent, T. A. ; Yeakley, J. ; Bruce, D. ; Eisenberg, H. M. ; McComb, J. G. ; Rekate, H. L. / Frontal lobe changes after severe diffuse closed head injury in children : A volumetric study of magnetic resonance imaging. In: Neurosurgery. 1995 ; Vol. 37, No. 3. pp. 392-400.
@article{d09b4e54acab4c09a27cf5f25620ae61,
title = "Frontal lobe changes after severe diffuse closed head injury in children: A volumetric study of magnetic resonance imaging",
abstract = "IN VIEW OF the pathophysiology and biomechanics of severe closed head injury (CHI) in children, we postulated that the frontal lobes sustain diffuse injury, even in the absence of focal brain lesions detected by magnetic resonance imaging (MRI). This study quantitated the morphological effects of CHI on the frontal lobes in children who sustained head trauma of varying severity. The MRI findings of 14 children who had sustained severe CHIs (Glasgow Coma Scale score of ≤8) were compared with the findings in a matched group of 14 children having sustained mild head injuries (Glasgow Coma Scale score of 13-15). The patients ranged in age from 5 to 15 years at the time of their MRIs, which were acquired at least 3 months postinjury. MRI findings revealed no focal areas of abnormal signal in the frontal lobes. Volumetric analysis disclosed that the total prefrontal cerebrospinal fluid increased and the gray matter volume decreased in the patients with severe CHI, relative to the mildly injured comparison group. Gray matter volume was also reduced in the orbitofrontal and dorsolateral regions of the brains of children with severe CHI, relative to the children who sustained mild head trauma. These volumetric findings indicate that prefrontal tissue loss occurs after severe CHI in children, even in the absence of focal brain lesions in this area. Nearly two-thirds of the children who sustained severe CHIs were moderately disabled after an average postinjury interval of 3 years or more, whereas 12 of the 14 patients with mild CHIs attained a good recovery (2 were moderately disabled) by the time of study. Although this initial study of brain morphometry after CHI in children was not designed to isolate the contribution of frontal lobe damage to residual disability, further research involving a larger sample is in progress to address this issue.",
keywords = "Children, Closed head injury, Magnetic resonance imaging",
author = "P. Berryhill and Lilly, {M. A.} and Levin, {H. S.} and Hillman, {G. R.} and D. Mendelsohn and Brunder, {D. G.} and Fletcher, {J. M.} and J. Kufera and Kent, {T. A.} and J. Yeakley and D. Bruce and Eisenberg, {H. M.} and McComb, {J. G.} and Rekate, {H. L.}",
year = "1995",
language = "English (US)",
volume = "37",
pages = "392--400",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Frontal lobe changes after severe diffuse closed head injury in children

T2 - A volumetric study of magnetic resonance imaging

AU - Berryhill, P.

AU - Lilly, M. A.

AU - Levin, H. S.

AU - Hillman, G. R.

AU - Mendelsohn, D.

AU - Brunder, D. G.

AU - Fletcher, J. M.

AU - Kufera, J.

AU - Kent, T. A.

AU - Yeakley, J.

AU - Bruce, D.

AU - Eisenberg, H. M.

AU - McComb, J. G.

AU - Rekate, H. L.

PY - 1995

Y1 - 1995

N2 - IN VIEW OF the pathophysiology and biomechanics of severe closed head injury (CHI) in children, we postulated that the frontal lobes sustain diffuse injury, even in the absence of focal brain lesions detected by magnetic resonance imaging (MRI). This study quantitated the morphological effects of CHI on the frontal lobes in children who sustained head trauma of varying severity. The MRI findings of 14 children who had sustained severe CHIs (Glasgow Coma Scale score of ≤8) were compared with the findings in a matched group of 14 children having sustained mild head injuries (Glasgow Coma Scale score of 13-15). The patients ranged in age from 5 to 15 years at the time of their MRIs, which were acquired at least 3 months postinjury. MRI findings revealed no focal areas of abnormal signal in the frontal lobes. Volumetric analysis disclosed that the total prefrontal cerebrospinal fluid increased and the gray matter volume decreased in the patients with severe CHI, relative to the mildly injured comparison group. Gray matter volume was also reduced in the orbitofrontal and dorsolateral regions of the brains of children with severe CHI, relative to the children who sustained mild head trauma. These volumetric findings indicate that prefrontal tissue loss occurs after severe CHI in children, even in the absence of focal brain lesions in this area. Nearly two-thirds of the children who sustained severe CHIs were moderately disabled after an average postinjury interval of 3 years or more, whereas 12 of the 14 patients with mild CHIs attained a good recovery (2 were moderately disabled) by the time of study. Although this initial study of brain morphometry after CHI in children was not designed to isolate the contribution of frontal lobe damage to residual disability, further research involving a larger sample is in progress to address this issue.

AB - IN VIEW OF the pathophysiology and biomechanics of severe closed head injury (CHI) in children, we postulated that the frontal lobes sustain diffuse injury, even in the absence of focal brain lesions detected by magnetic resonance imaging (MRI). This study quantitated the morphological effects of CHI on the frontal lobes in children who sustained head trauma of varying severity. The MRI findings of 14 children who had sustained severe CHIs (Glasgow Coma Scale score of ≤8) were compared with the findings in a matched group of 14 children having sustained mild head injuries (Glasgow Coma Scale score of 13-15). The patients ranged in age from 5 to 15 years at the time of their MRIs, which were acquired at least 3 months postinjury. MRI findings revealed no focal areas of abnormal signal in the frontal lobes. Volumetric analysis disclosed that the total prefrontal cerebrospinal fluid increased and the gray matter volume decreased in the patients with severe CHI, relative to the mildly injured comparison group. Gray matter volume was also reduced in the orbitofrontal and dorsolateral regions of the brains of children with severe CHI, relative to the children who sustained mild head trauma. These volumetric findings indicate that prefrontal tissue loss occurs after severe CHI in children, even in the absence of focal brain lesions in this area. Nearly two-thirds of the children who sustained severe CHIs were moderately disabled after an average postinjury interval of 3 years or more, whereas 12 of the 14 patients with mild CHIs attained a good recovery (2 were moderately disabled) by the time of study. Although this initial study of brain morphometry after CHI in children was not designed to isolate the contribution of frontal lobe damage to residual disability, further research involving a larger sample is in progress to address this issue.

KW - Children

KW - Closed head injury

KW - Magnetic resonance imaging

UR - http://www.scopus.com/inward/record.url?scp=0029087286&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029087286&partnerID=8YFLogxK

M3 - Article

C2 - 7501101

AN - SCOPUS:0029087286

VL - 37

SP - 392

EP - 400

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 3

ER -