Article

Le traumatisme crânien de l’enfant

Inserm 731 UPMC, Paris-VI 47, boulevard de l’hôpital F-75013 Paris France
La Lettre de médecine physique et de réadaptation 03/2008; 24(1):26-30. DOI: 10.1007/s11659-008-0090-2

ABSTRACT Les mécanismes sont dominés par les chutes pour les plus jeunes et par les accidents de la voie publique pour les plus grands.
Chez les plus jeunes, les lésions les plus graves entrent dans le cadre du syndrome du bébé secoué. Le pronostic en cas de
lésions diffuses est moins bon que celui de l’adulte. Si la récupération motrice est souvent satisfaisante et rapide, restent
les atteintes cognitives et surtout comportementales, qui constituent le handicap « invisible » et déterminent le pronostic.
L’organisation des soins doit particulièrement veiller à leur spécificité et à leur continuité. La famille et l’école jouent
un rôle privilégié. La réparation au sens juridique du terme, lorsqu’elle est possible, ne doit pas être négligée.
Brain injury in children is mainly caused by falls, for young children, and by road accidents for older ones. In young children,
the most serious injuries found are in the context of the shaken baby syndrome. The prognosis for extended injuries is worse
than in adults. If motor recovery is often satisfactory and quick, there are still cognitive effects and particularly behavioural
effects, which are “invisible”; handicaps and determine the prognosis. Treatment must pay particular attention to their specificity
and continuity. Family and school play an important role. Compensation, in the legal sense, when possible, should not be neglected.

0 Followers
 · 
98 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: To analyze the relationship between craniospinal irradiation (CSI) and intellectual outcome in children with posterior fossa (PF) tumors. A neuropsychological evaluation was performed retrospectively in 31 children, aged 5-15 years, who had received radiotherapy for PF tumors, and who had been off therapy for at least 1 year. Factors evaluated for impact on intellectual outcome were: socioeconomic status, disease presentation, histology, complications, chemotherapy, age at radiotherapy, interval between radiotherapy and testing, and radiation doses and volumes. Patients were divided into 3 subgroups according to the CSI doses (0 Gy [i.e., PF irradiation only], 25 Gy, and 35 Gy), with 11, 11, and 9 patients, respectively. Long-term cognitive impairment occurred in most of the patients, even after PF irradiation only. Moreover, there was a significant correlation between the full-scale IQ score (FSIQ) and the CSI dose, with mean FSIQ scores at 84.5 (SD = 14.0), 76.9 (SD = 16.6), and 63.7 (SD = 15.4) for 0 Gy, 25 Gy, and 35 Gy of CS1, respectively. A marked drop in verbal comprehension scores was noted in children who had received the higher dose. This preliminary study further supports the rationale for de-escalation of CSI doses and volumes in standard-risk PF tumors.
    International Journal of Radiation OncologyBiologyPhysics 09/1999; 45(1):137-45. DOI:10.1016/S0360-3016(99)00177-7 · 4.18 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Long-term follow-up five to 13 (mean seven years) of 13 cases of whiplash-shaken-infant syndrome (WSIS) demonstrated long sign-free intervals. Full clinical appearance of neurological deficits takes four months for the interruption of brain growth, six to 12 months for lesions of the central nervous system long pathways, up to two years for epilepsy, and three to six years for behavioural and neuropsychological signs. In our series, WSIS occurred at a mean postnatal age of 5.5 months and caused intracranial, retinal and preretinal haemorrhages, intracranial haematomas, oedema, contusional tears, and developmental disturbances interfering with the growth and differentiation of neural tissue and with synaptic stabilisation. These mechanisms account for the long sign-free interval that makes its impossible to formulate a precise and final neurological prognosis before the age of school entrance. Only one of our patients seems to have remained normal even several years after the shaking.
    Developmental Medicine & Child Neurology 12/1995; 37(11):943-56. DOI:10.1111/j.1469-8749.1995.tb11949.x · 3.29 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Planning, which concerns many activities in everyday life, is a two-stage process. The first one predetermines a course of actions aimed at achieving some specific goals. It is founded on managerial knowledge or overlearned sequences of events and may be tested by script generation. The second stage entails monitoring and guiding the execution of the plan to a successful conclusion. It must take into account environmental contingencies and may be tested by script execution. If the frontal lobes intervene not only in managerial knowledge (Grafman, 1989) but also in binding the plan with contextual environment (Damasio, Tranel and Damasio, 1991; Shallice and Burgess, 1991), script execution would be more sensitive than script generation to planning deficits. To test this hypothesis, script execution and script generation were compared in 11 patients with a dysexecutive syndrome and 10 matched controls, using three scripts of daily life activities: (1) 'shopping for groceries'; (2) 'cooking'; (3) 'answering a letter and finding the way to post the reply'. Two way ANOVAs showed more errors in execution than in generation, more errors in patients than in controls, and a greater difference between execution and generation in patients than in controls. Furthermore, 'context neglect' and 'environmental adherence' were the two types of errors that best differentiated patients from controls. Finally, the total number of errors in execution correlated with the score on behavioral questionnaires answered by occupational therapists. These results confirm our hypothesis and suggest that script execution may be a valid ecological approach to estimate the severity of deficits in daily life activities.
    Cortex 01/2001; 36(5):649-69. DOI:10.1016/S0010-9452(08)70543-4 · 6.04 Impact Factor