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Pediatrik Kafa Travması Hastalarında Diffüz Aksonal Hasar Sonrası Kalıcı Nörokognitif Sekele Etki Eden Faktörler

Year 2020, Volume: 14 Issue: 5, 379 - 384, 29.09.2020
https://doi.org/10.12956/tchd.768523

Abstract

Amaç: Bir parankimal travmatik hasarlanma tipi olan diffüz aksonal hasar (DAH), kafa travması geçiren çocuk hastalarda akut ve kronik dönemde ciddi nörokognitif bozukluklara sebep olabilmektedir. Bu çalışmada klinik ve radyolojik bulgulardan hangilerinin ağır hasar ile ilişkili olduğunu saptanması amaçlanmıştır.
Gereç ve Yöntem: Çalışmamızda 2012-2017 yılları arasında ağır kafa travması sonrası çocuk yoğun bakım ünitesinde izlenen otuz dokuz hastanın verileri incelenmiştir. DAH ön tanısı ile manyetik rezonans görüntüleme (MRG) yapılmış hastaların başvurudaki yaş, Glasgow Koma Skalası (GKS), Pediatric Risk of Mortality (PRISM) skoru, taburculukta Glasgow Outcome Skalası (GOS), vital bulgular, laboratuvar bulguları, hastanede kalma sürelerine ulaşılmıştır. DAH ile uyumlu lezyon yükü, ayrıca bu lezyonların beyindeki anatomik yerleşimleri not edilmiştir. DAH (+) saptanan grup ile saptanmayan grup karşılaştırılmış, ayrıca hangi parametrelerin GOS üzerinde anlamlı etkisi olduğu incelenmiştir.
Sonuçlar ve Tartışma: Hastaların 29’unda DAH ile uyumlu MRG bulgusu saptanırken, kalan 10 hastada ise beyin MRG’de DAH saptanmadı. Bu iki grubun karşılaştırılmasında PRISM, GOS ve GKS skorları ve hastanede yatış süreleri farklı bulunmuştur. DAH (+) hasta grubunda GKS ve PRISM skorlarının, ayrıca hastane yatış süresinin GOS ile anlamlı korelasyonu saptanmıştır. Hastalarda toplam lezyon yükü ile GKS ya da GOS arasında anlamlı bir ilişki bulunamamıştır. Talamus ve beyin sapında lezyon bulunan hastalarda GKS diğer hastalara göre anlamlı düşüklük bulunurken GOS ile ilgili böyle bir ilişki gösterilememiştir. Çalışmamızın sonuçları diffüz aksonal hasarın hafif kafa travmalarına göre daha ciddi nörokognitif bozukluğa sebep olduğunu, uzun hastane yatışı ve rehabilitasyon gerektirdiğini göstermektedir. Ancak prognoz ve kalıcı hasar için belirleyici faktörler konusunda hem klinik hem de radyolojik bulguları içeren geniş kohort çalışmalara ihtiyaç vardır.

References

  • Referans1 Kochanek PM, Tasker RC, Carney N, Totten AM, Adelson PD, Selden NR, et al. Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition: Update of the Brain Trauma Foundation Guidelines, Executive Summary. Neurosurgery 2019;84:1169-1178.
  • Referans2 Vavilala MS, Kernic MA, Wang J, Kannan N, Mink RB, Wainwright MS, et al. Pediatric Guideline Adherence and Outcomes Study. Acute care clinical indicators associated with discharge outcomes in children with severe traumatic brain injury. Crit Care Med 2014;42:2258-2266.
  • Referans3 Kannan N, Wang J, Mink RB, Wainwright MS, Groner JI, Bell MJ, et al; PEGASUS (Pediatric Guideline Adherence Outcomes) Study. Timely Hemodynamic Resuscitation and Outcomes in Severe Pediatric Traumatic Brain Injury: Preliminary Findings. Pediatr Emerg Care 2018;34:325-329.
  • Referans4 Moran LM, Babikian T, Del Piero L, Ellis MU, Kernan CL, Newman N, et al. The UCLA study of Predictors of Cognitive Functioning Following Moderate/Severe Pediatric Traumatic Brain Injury. J Int Neuropsychol Soc 2016;22:512-519.
  • Referans5 Wainwright MS, Grimason M, Goldstein J, Smith CM, Amlie-Lefond C, Revivo G, et al. Building a pediatric neurocritical care program: a multidisciplinary approach to clinical practice and education from the intensive care unit to the outpatient clinic. Semin Pediatr Neurol 2014;21:248-254.
  • Referans6 Pineda JA, Leonard JR, Mazotas IG, Noetzel M, Limbrick DD, Keller MS, et al. Effect of implementation of a paediatric neurocritical care programme on outcomes after severe traumatic brain injury: a retrospective cohort study. Lancet Neurol 2013;12:45-52.
  • Referans7 Davceva N, Basheska N, Balazic J. Diffuse axonal injury-A distinct clinicopathological entity in closed head injuries. Am J Forensic Med Pathol 2015;36:127e33.
  • Referans8 Vander Linden C, Verhelst H, Genbrugge E, Deschepper E, Caeyenberghs K, Vingerhoets G, et al. Is diffuse axonal injury on susceptibility weighted imaging a biomarker for executive functioning in adolescents with traumatic brain injury?. Eur J Paediatr Neurol 2019;23:525-536.
  • Referans9 Dennis EL, Babikian T, Giza CC, Thompson PM, Asarnow RF. Diffusion MRI in pediatric brain injury. Childs Nerv Syst 2017;33:1683-1692.
  • Referans10 Weeks D, Sullivan S, Kilbaugh T, Smith C, Margulies SS. Influences of developmental age on the resolution of diffuse traumatic intracranial hemorrhage and axonal injury. J Neurotrauma 2014;31:206-214.
  • Referans11 Beauchamp MH, Beare R, Ditchfield M, Coleman L, Babl FE, Kean M, et al. Susceptibility weighted imaging and its relationship to outcome after pediatric traumatic brain injury. Cortex 2013;49:591-598.
  • Referans12 Moen KG, Brezova V, Skandsen T, Haberg AK, Folvik M, Vik A. Traumatic axonal injury: the prognostic value of lesion load in corpus callosum, brain stem, and thalamus in different magnetic resonance imaging sequences. J Neurotrauma 2014;31:1486e96.
  • Referans13 Abu Hamdeh S, Marklund N, Lannsjo M, Howells T, Raininko R, Wikstrom J, et al. Extended anatomical grading in diffuse axonal injury using MRI: hemorrhagic lesions in the substantia nigra and mesencephalic tegmentum indicate poor long-term outcome. J Neurotrauma 2017;34:341e52.
  • Referans14 Babikian T, Freier MC, Tong KA, Nickerson JP, Wall CJ, Holshouser BA, et al. Susceptibility weighted imaging: neuropsychologic outcome and pediatric head injury. Pediatr Neurol 2005;33:184-194.
  • Referans15 Dennis EL, Hua X, Villalon-Reina J, Moran LM, Kernan C, Babikian T, et al. Tensor-Based Morphometry Reveals Volumetric Deficits in Moderate-Severe Pediatric Traumatic Brain Injury. J Neurotrauma 2016;33:840-852.
  • Referans16 Dennis EL, Jin Y, Villalon-Reina JE, Zhan L, Kernan CL, Babikian T, et al. White matter disruption in moderate/severe pediatric traumatic brain injury: advanced tract-based analyses. Neuroimage Clin 2015;7:493-505.
  • Referans17 Dennis EL, Ellis MU, Marion SD, Jin Y, Moran L, Olsen A, et al. Callosal Function in Pediatric Traumatic Brain Injury Linked to Disrupted White Matter Integrity. J Neurosci ;35:10202-10211.
  • Referans18 Babikian T, Alger JR, Ellis-Blied MU, Giza CC, Dennis E, Olsen A, et al. Whole Brain Magnetic Resonance Spectroscopic Determinants of Functional Outcomes in Pediatric Moderate/Severe Traumatic Brain Injury. J Neurotrauma 2018;35:1637-1645.
Year 2020, Volume: 14 Issue: 5, 379 - 384, 29.09.2020
https://doi.org/10.12956/tchd.768523

Abstract

References

  • Referans1 Kochanek PM, Tasker RC, Carney N, Totten AM, Adelson PD, Selden NR, et al. Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition: Update of the Brain Trauma Foundation Guidelines, Executive Summary. Neurosurgery 2019;84:1169-1178.
  • Referans2 Vavilala MS, Kernic MA, Wang J, Kannan N, Mink RB, Wainwright MS, et al. Pediatric Guideline Adherence and Outcomes Study. Acute care clinical indicators associated with discharge outcomes in children with severe traumatic brain injury. Crit Care Med 2014;42:2258-2266.
  • Referans3 Kannan N, Wang J, Mink RB, Wainwright MS, Groner JI, Bell MJ, et al; PEGASUS (Pediatric Guideline Adherence Outcomes) Study. Timely Hemodynamic Resuscitation and Outcomes in Severe Pediatric Traumatic Brain Injury: Preliminary Findings. Pediatr Emerg Care 2018;34:325-329.
  • Referans4 Moran LM, Babikian T, Del Piero L, Ellis MU, Kernan CL, Newman N, et al. The UCLA study of Predictors of Cognitive Functioning Following Moderate/Severe Pediatric Traumatic Brain Injury. J Int Neuropsychol Soc 2016;22:512-519.
  • Referans5 Wainwright MS, Grimason M, Goldstein J, Smith CM, Amlie-Lefond C, Revivo G, et al. Building a pediatric neurocritical care program: a multidisciplinary approach to clinical practice and education from the intensive care unit to the outpatient clinic. Semin Pediatr Neurol 2014;21:248-254.
  • Referans6 Pineda JA, Leonard JR, Mazotas IG, Noetzel M, Limbrick DD, Keller MS, et al. Effect of implementation of a paediatric neurocritical care programme on outcomes after severe traumatic brain injury: a retrospective cohort study. Lancet Neurol 2013;12:45-52.
  • Referans7 Davceva N, Basheska N, Balazic J. Diffuse axonal injury-A distinct clinicopathological entity in closed head injuries. Am J Forensic Med Pathol 2015;36:127e33.
  • Referans8 Vander Linden C, Verhelst H, Genbrugge E, Deschepper E, Caeyenberghs K, Vingerhoets G, et al. Is diffuse axonal injury on susceptibility weighted imaging a biomarker for executive functioning in adolescents with traumatic brain injury?. Eur J Paediatr Neurol 2019;23:525-536.
  • Referans9 Dennis EL, Babikian T, Giza CC, Thompson PM, Asarnow RF. Diffusion MRI in pediatric brain injury. Childs Nerv Syst 2017;33:1683-1692.
  • Referans10 Weeks D, Sullivan S, Kilbaugh T, Smith C, Margulies SS. Influences of developmental age on the resolution of diffuse traumatic intracranial hemorrhage and axonal injury. J Neurotrauma 2014;31:206-214.
  • Referans11 Beauchamp MH, Beare R, Ditchfield M, Coleman L, Babl FE, Kean M, et al. Susceptibility weighted imaging and its relationship to outcome after pediatric traumatic brain injury. Cortex 2013;49:591-598.
  • Referans12 Moen KG, Brezova V, Skandsen T, Haberg AK, Folvik M, Vik A. Traumatic axonal injury: the prognostic value of lesion load in corpus callosum, brain stem, and thalamus in different magnetic resonance imaging sequences. J Neurotrauma 2014;31:1486e96.
  • Referans13 Abu Hamdeh S, Marklund N, Lannsjo M, Howells T, Raininko R, Wikstrom J, et al. Extended anatomical grading in diffuse axonal injury using MRI: hemorrhagic lesions in the substantia nigra and mesencephalic tegmentum indicate poor long-term outcome. J Neurotrauma 2017;34:341e52.
  • Referans14 Babikian T, Freier MC, Tong KA, Nickerson JP, Wall CJ, Holshouser BA, et al. Susceptibility weighted imaging: neuropsychologic outcome and pediatric head injury. Pediatr Neurol 2005;33:184-194.
  • Referans15 Dennis EL, Hua X, Villalon-Reina J, Moran LM, Kernan C, Babikian T, et al. Tensor-Based Morphometry Reveals Volumetric Deficits in Moderate-Severe Pediatric Traumatic Brain Injury. J Neurotrauma 2016;33:840-852.
  • Referans16 Dennis EL, Jin Y, Villalon-Reina JE, Zhan L, Kernan CL, Babikian T, et al. White matter disruption in moderate/severe pediatric traumatic brain injury: advanced tract-based analyses. Neuroimage Clin 2015;7:493-505.
  • Referans17 Dennis EL, Ellis MU, Marion SD, Jin Y, Moran L, Olsen A, et al. Callosal Function in Pediatric Traumatic Brain Injury Linked to Disrupted White Matter Integrity. J Neurosci ;35:10202-10211.
  • Referans18 Babikian T, Alger JR, Ellis-Blied MU, Giza CC, Dennis E, Olsen A, et al. Whole Brain Magnetic Resonance Spectroscopic Determinants of Functional Outcomes in Pediatric Moderate/Severe Traumatic Brain Injury. J Neurotrauma 2018;35:1637-1645.
There are 18 citations in total.

Details

Primary Language Turkish
Subjects ​Internal Diseases
Journal Section ORIGINAL ARTICLES
Authors

Filiz Yetimakman 0000-0002-9334-4464

Rahşan Göçmen 0000-0002-0223-9336

Publication Date September 29, 2020
Submission Date July 14, 2020
Published in Issue Year 2020 Volume: 14 Issue: 5

Cite

Vancouver Yetimakman F, Göçmen R. Pediatrik Kafa Travması Hastalarında Diffüz Aksonal Hasar Sonrası Kalıcı Nörokognitif Sekele Etki Eden Faktörler. Türkiye Çocuk Hast Derg. 2020;14(5):379-84.


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