Title : Hemorrhagic diffuse axonal injury in pediatric populations: contemporary incidence and prognostic factors
Abstract:
Introduction: Diffuse axonal injury (DAI) typically refers to the shearing of white matter tracts secondary to rotational or rapid acceleration-deceleration forces. Prognosis of DAI is determined by the severity of injury and generally correlates with several variables: age, timing, imaging findings, mechanism of damage, and location of damage. Children are at a higher risk of developing DAI due to lesser myelination and relatively increased cerebral water levels; however, much of the literature on DAI prognostication focuses on adult cases. This article aims to serve as a contemporary review of the incidence of pediatric hemorrhagic DAI and its associations with DAI severity, as ascertained by the Adams et. al. grading system, injury severity score (ISS), and Glasgow Coma Scale (GCS) score.
Methods: A literature review was conducted using PubMed. The search string “pediatric diffuse axonal injury” was employed to identify review articles and research studies detailing pediatric DAI.
Results: 584 pediatric DAI cases were identified in our literature review, and intracranial hemorrhage (ICH) was present in 389 of these. 206, 139, 53, and 16 subarachnoid hemorrhages, subdural hematomas, epidural hematomas, and intraventricular hemorrhages were identified, respectively. Furthermore, a total of 2959 focal intraparenchymal hemorrhagic lesions were collectively identified within 58 cases in which lesion counts were explicitly enumerated.
Conclusions: Overall, subarachnoid hemorrhage had the highest incidence of cases, while the greatest volume of hemorrhage within individual DAI cases was associated with intraparenchymal hemorrhage. Notably, poor DAI prognostication in intraparenchymal hemorrhage cases correlated most strongly with the location of lesions, specifically the corpus callosum and deep subcortical regions.
