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MINOR HEAD INJURY & MEDIAL TEMPORAL DAMAGE

MINOR HEAD INJURY & MEDIAL TEMPORAL DAMAGE. A PROSPECTIVE CONTROLLED STUDY USING SPECT. Deepak Agrawal, Naveen K*, C S Bal*, A K Mahapatra Departments of Neurosurgery and *Nuclear medicine, All India Institute of Medical Sciences, New Delhi. BACKGROUND EXPERIMENTAL EVIDENCE

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MINOR HEAD INJURY & MEDIAL TEMPORAL DAMAGE

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  1. MINOR HEAD INJURY & MEDIAL TEMPORAL DAMAGE A PROSPECTIVE CONTROLLED STUDY USING SPECT • Deepak Agrawal, Naveen K*, C S Bal*, A K Mahapatra • Departments of Neurosurgery and *Nuclear medicine, All India Institute of Medical Sciences, New Delhi

  2. BACKGROUND EXPERIMENTAL EVIDENCE Bilateral dentate hilar neuron loss is a consistent finding two weeks after minor head injury and is uniformly associated with memory dysfunction Smith DH, Lowenstein DH, Gennarelli DI, McIntosh TK. Persistent memory dysfunction is associated with bilateral hippocampal damage following experimental brain injury. Neurosci Lett 1994;168:151-154

  3. WHY MEDIAL TEMPORAL LOBE? • Hippocampus is especially vulnerable to insults such as ischemia, hypoxia, and seizures • Extent of hippocampal damage may be correlated with severity of memory impairment Rempel-Clower NL, Zola SM, Squire LR, Amaral DG. Three cases of enduring memory impairment after bilateral damage limited to the hippocampal formation. J Neurosci 1996;16:5233-5255.

  4. AIMS & OBJECTIVES • Document medial temporal hypoperfusion (MTH) on SPECT in children with minor head injury • To evaluate MTH on SPECT as a risk factor for development of persistent postconcussion syndrome (PPCS) at three months

  5. MATERIALS AND METHODS • PROSPECTIVE STUDY • PERIOD- Nov 2001 TO Oct 2002

  6. MINOR HEAD INJURY • Loss of consciousness <30 minutes. • GCS score 13 to 15. • Posttraumatic amnesia <24 hours. [criteria published by the members of the Mild Traumatic brain injury Interdisciplinary Special Interest Group (BISIG)] Kay T, Harrington DE, et al. Definition of mild traumatic brain injury. J Head Trauma Rehabil 1993;8:86

  7. POSTCONCUSSION SYNDROME The Post Concussion Syndrome Checklist score (PCSC)- via discussion with parent & child Gouvier WD, Cubic B, Jones G, Brantly P, Cutlip Q. Postconcussion symptoms and daily stress in normal and head-injured college populations. Arch Clin Neuropsychol 1992;7:193-211.

  8. NCCT head INVESTIGATION • Clinical (PCSC) • SPECT scan brain (Within 72 hours & at 3 mths of injury )

  9. STUDY DESIGN

  10. SPECT scanning was done using 99Tcm-ECD on a dual headed GE 'Varicam' scanner. • The final data was displayed on a 10 grade color scale and semi quantitative analysis performed. SPECT

  11. ABNORMAL SPECT SCAN Regional cerebral perfusion <10% of contralateral lobe, or in case of bilateral involvement, less than 20% of cerebellum

  12. RESULTS 12 children were found to have cognitive dysfunction in the MTH group compared to only two in the control group Relative risk (95% CI)= 6.86(1.84-25.51). P=0.0003

  13. RESULTS

  14. RESULTS

  15. ADVANTAGES OF SPECT • Certain skills are age dependent- Injury in the preschool years seems to affect the process of learning to read. • SPECT may help in identification and prognostication in this subgroup of children

  16. CONCLUSIONS • Children with medial temporal hypoperfusion are much more likely to develop memory & learning disorders

  17. CONCLUSIONS • Ours is the first study of its kind correlating medial temporal hypoperfusion on SPECT with persistent cognitive dysfunction in children • SPECT-platform for testing the efficacy of various neurobehavioural and pharmacological interventions.

  18. THANK YOU

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