Brain Lesion Load Impacts Long-Term Outcomes in Pediatric TBI

While many lesions remained at 1 year, reductions in lesion volume correlated with improved neurologic outcomes.

VANCOUVER – The number and volume of hemorrhagic brain lesions on MRI predicts neurologic and neuropsychological outcomes 1 year after traumatic brain injury in pediatric patients, according to data presented at the 2016 Child Neurology Society Annual Meeting, October 26-29, 2016 in Vancouver, British Columbia.

In order to better understand the long-term effects of lesion load on neurological outcomes, Stephen Ashwal, MD, of Loma Linda University in California, and colleagues analyzed susceptibility weighted 3 Tesla MRI scans in 75 children (54 male, 21 female; mean age= 12 years) with moderate-to-severe and complicated mild TBI 6-18 days post-injury, and at 1 year.

The patients sustained injury from vehicle or bike accidents (n=48), falls (n=20), sports (n=6), or assaults (n=1). Glasgow Coma Scale (GCS) scores were mild in 28 participants, moderate in 11 participants, and severe in 36 participants. Neurologic (measured with Pediatric Cerebral Performance Categories scale [PCPCs]) and neuropsychological (memory, attention, IQ) outcomes were compared with lesion load at 1-year follow-up.

Susceptibility weighted imaging showed that the most severely injured patients had the greatest number and volume of lesions. Lesion number and volume was negatively correlated with 1-year neurologic outcomes (P=.000 and P=.001, respectively) and neuropsychological outcomes for memory (P=.000 and P=.005, respectively) and attention (P=.000 and P=.002, respectively). No significant correlation was identified with IQ.

In the 70 patients who underwent follow-up MRI, approximately 50% of lesions remained, however, improvement in lesion volume correlated with improvement in neurologic outcomes.

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Ashwal S, Al-Ramadhani R, Pivonka-Jones J, et al. Hemorrhagic MRI Brain Lesions are associated with One-Year Outcomes after Pediatric TBI. Presented at: 2016 Child Neurology Society Annual Meeting. October 26-29, 2016; Vancouver, BC. Abstract 110.