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2015 ; 55
(6
): 510-8
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Cerebral Infarction following Acute Subdural Hematoma in Infants and Young
Children: Predictors and Significance of FLAIR Vessel Hyperintensity
#MMPMID26041626
Momose H
; Sorimachi T
; Aoki R
; Atsumi H
; Matsumae M
Neurol Med Chir (Tokyo)
2015[]; 55
(6
): 510-8
PMID26041626
show ga
A phenomenon of cerebral infarction following acute subdural hematoma (ASDH) in
infants and young children, termed cerebral infarction following ASDH (CIASDH),
has been well recognized, though both its mechanisms and risk factors have been
poorly understood. The purpose of the present study was to investigate the
predictors for CIASDH in a population of ASDH, and to evaluate the imaging
studies to presume the mechanisms of CIASDH. We retrospectively examined
consecutive children 6 years of age or younger, who were diagnosed with ASDH and
were admitted to our hospital between 2000 and 2014. In 57 consecutive children
with ASDH, 12 (21.1%) developed CIASDH. The multivariate analysis revealed five
predictors for CIASDH: presence of seizure, consciousness disturbance at
admission, absence of skull fracture, hematoma thickness ? 5 mm on computed
tomography (CT), and midline shift ? 3 mm on CT (p < 0.05). In three of six
patients (50%) undergoing magnetic resonance (MR) imaging/fluid-attenuated
inversion recovery (FLAIR) within 5 days of admission, serpentine
hyperintensities in the subarachnoid space (FLAIR vessel hyperintensities) were
demonstrated. MR angiography showed neither occlusion nor stenosis of the
cerebral arteries. Single photon emission CT performed at admission in one
patient showed a cerebral blood flow reduction in the ASDH side. All the children
with CIASDH showed unfavorable outcomes at discharge. Children showing multiple
predictors at admission should be carefully observed for development of CIASDH.
Evaluation of the imaging studies suggested that a blood flow disturbance in the
level of peripheral arteries to microcirculation was one candidate for possible
mechanisms to induce the CIASDH.