Citation

Bonow RH, Friedman SD, Perez FA, Ellenbogen RG, Browd SR, Macdonald CL, Vavilala MS, Rivara FP. J. Neurotrauma 2017; 34(19): 2706-2712.

Affiliation

Harborview Medical Center, 21618, Harborview Injury Prevention Research Center, Seattle, Washington, United States ; fpr@uw.edu.

Copyright

(Copyright © 2017, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2017.4970

PMID

28490224

Abstract

A subset of patients experience persistent symptoms after pediatric concussion, and magnetic resonance imaging (MRI) is commonly used to evaluate for pathology. The utility of this practice is unclear. We conducted a retrospective cohort study to describe the MRI findings in children with concussion. A registry of all patients seen at our institution from January 2010 through March 2016 with pediatric sports-related concussion was cross-referenced with a database of radiographic studies. Radiology reports were reviewed for abnormal findings. Patients with abnormal CTs or MRI scans ordered for reasons other than concussion were excluded. Among 3,338 children identified with concussion, 427 underwent MRI. Only two (0.5%) had findings compatible with traumatic injury, consisting in both of microhemorrhage. Sixty-one patients (14.3%) had abnormal findings unrelated to trauma, including 24 nonspecific T2 changes, 15 pineal cysts, eight Chiari I malformations, and five arachnoid cysts. One child underwent craniotomy for a cerebellar hemangioblastoma after presenting with ataxia; another had cortical dysplasia resected after seizure. The two patients with microhemorrhage each had three prior concussions, significantly more than patients whose scans were normal (median: 1) or abnormal without injury (median: 1.5; P = 0.048). MRI rarely revealed intracranial injuries in children after concussion, and the clinical relevance of these uncommon findings remains unclear. Abnormalities unrelated to trauma are usually benign. However, MRI should be thoughtfully considered in children who present with concerning or atypical symptoms.

Language: en

Keywords

HEAD TRAUMA; MRI; PEDIATRIC BRAIN INJURY