Le traumatisme crânien de l’enfant

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La Lettre de médecine physique et de réadaptation 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.

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    ABSTRACT: Magnetic resonance imaging (MRI) may provide an estimate of the severity of diffuse axonal injury by quantitative measurements of atrophy of white matter tracts (such as corpus callosum) and of ventricular enlargement (particularly the third ventricle). However, most MRI studies failed to reveal consistent relationships between the pattern of neuropsychological impairments and the site and extent of focal structural lesions after traumatic brain injury. Functional neuroimaging techniques, such as positron emission tomography or functional MRI, may reveal areas of cerebral dysfunction in regions that look structurally intact on MRI. Studies using these techniques have suggested that the cognitive and behavioural disturbances of traumatic brain injury could be related to a defective activation of a prefrontal-cingulate network.
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    ABSTRACT: The question of whether any adverse cognitive or psychosocial outcomes occur after mild head injury in early childhood has evoked considerable controversy. This study examined mild head injury before age 10 and potential differences in late childhood/early adolescence as a function of severity of mild injury and age at injury. A fully prospective longitudinal design tracked a large birth cohort of children. Confirmed cases of mild head injury before age 10 were divided on the basis of outpatient medical attention (n=64-84) or inpatient observation (hospital overnight; n=26-28 ) and compared with the non-injured remainder of the cohort (reference group; n=613-807). A range of pre-injury and post-injury child and family characteristics were used to control for any potential confounds. Outcome after injury before and after age 5 was also assessed. After accounting for several demographic, family, and pre-injury characteristics, the inpatient but not the outpatient group displayed increased hyperactivity/inattention and conduct disorder between ages 10 to 13, as rated by both mothers and teachers. Psychosocial deficits were more prevalent in the inpatient subgroup injured before age 5. No clear effects were evident for various cognitive/academic measures, irrespective of severity of mild injury or age at injury. Most cases of mild head injury in young children do not produce any adverse effects, but long term problems in psychosocial function are possible in more severe cases, perhaps especially when this event occurs during the preschool years. The view that all mild head injuries in children are benign events requires revision and more objective measures are required to identify cases at risk.
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    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.
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