Clinical Comparison of the Predictive Value of the Simple Skull X-Ray and 3 Dimensional Computed Tomography for Skull Fractures of Children

OBJECTIVE: In the pediatric population the skull has not yet undergone ossification and it is assumed that the diagnostic rate of skull fractures by simple X-rays are lower than that of adults. It has been recently proposed that the diagnostic rates of skull fractures by 3-dimensional computer tomography (3D-CT) are higher than simple X-rays. The authors therefore attempted to compare the diagnostic rates of pediatric skull fractures by simple X-rays and 3D-CTs with respect to the type of fracture. METHODS: One-hundred patients aged less than 12 years who visited the Emergency Center for cranial injury were subject to simple X-rays and 3D-CTs. The type and location of the fractures were compared and Kappa statistical analysis and the t-test were conducted. RESULTS: Among the 100 pediatric patients, 65 were male and 35 were female. The mean age was 50+/-45 months. 63 patients had simple skull fractures and 22 had complex fractures, and the types of fractures were linear fractures in 74, diastatic fractures 15, depressed fractures in 10, penetrating fracture in 1, and greenstick fractures in 3 patients. Statistical difference was observed for the predictive value of simple skull fractures' diagnostic rate depending on the method for diagnosis. A significant difference of the Kappa value was noted in the diagnosis of depressed skull fractures and diastatic skull fractures. CONCLUSION: In the majority of pediatric skull fractures, 3D-CT showed superior diagnosis rates compared to simple skull X-rays and therefore 3D-CT is recommended whenever skull fractures are suspected. This is especially true for depressed skull fractures and diastatic skull fractures.

Cerebral Infarction Caused by Mild Head Injury in a Child with Iron Deficiency Anemia from Prolonged Breast Feeding: Case Report

A child who had iron deficiency anemia(IDA) resulted from the prolonged breast feeding presented with left side hemiparesis following mild head injury. The serial computed tomography and magnetic resonance imaging showed right internal carotid artery territory infarction. It has been generally accepted that prolonged breast feeding causes IDA. A few cases of infarction caused by IDA have been reported. A few cases of cerebral infarction caused by mild head injury have been also reported. However, few have been reported nonhemorrhagic cerebral infarction caused by mild head injury associated with IDA from prolonged breast feeding. We reviewed the literature that prolonged breast feeding causes IDA and in this case, mild head injury could cause the cerebral infarction. We think that it is important to have clinical suspicion of cerebral infarction in a child with IDA from prolonged breast feeding who has mild head injury because early diagnosis is difficult.

Effectiveness of Preoperative Extra-Ventricular Drainage in Poor Grade Aneurysmal Subarachnoid Hemorrhage / 대한뇌혈관학회지

OBJECTIVE: Preoperative extra-ventricular drainage in poor grade aneurysmal subarachnoid hemorrhage (SAH) patients has been known to improve patient's clinical grade. However, the risk of rebleeding due to increase of transmural pressure hinders its popular clinical use. The authors present new experience of preoperative extra-ventricular drainage in poor grade aneurysmal SAH. MATERIALS AND METHODS: From January 1996 to November 2001, 56 SAH patients underwent extra-ventricular drainage preoperatively. The mean age was 57.9 years (range 27 to 88). Hunt and Hess grade (HH grade) on the time of extra-ventricular drainage insertion were grade 3 in 4 patients, grade 4 in 35 patients and grade 5 in 17 patients. The overall clinical outcome of the patients who underwent extra-ventricular drainage and final clinical outcome according to the intervals between ventricular drainage and direct clipping/endovascular coiling were analysed retrospectively. RESULT: Twenty-six patients (46.4%) improved clinically (average HH grade was improved from 4.6 to 3.3), 25 patients (44.6%) have not been changed, 5 patients (9%) aggravated (4 to 5) after ventricular drainage. Seven of 30 unchanged or aggravated patients underwent CT scan which revealed rebleeding of the aneurysm. 32 patients (57.1%) were treated with surgery or endovascular coiling. Seventeen patients (30.4%) have lost their opportunity of ultimate treatment because they had poor clinical course after extra-ventricular drainage. Final clinical outcome was not statistically different between early therapeutic group who underwent operation within 24 hours after extra-ventricular drainage and delayed therapeutic group who underwent operation after 24 hours. (Fisher extract test, survival rate P=0.603, clinical outcome P=1.000). CONCLUSION: Preoperative extra-ventricular drainage had additional risk of rebleeding, however, it provides immediate improvement of patient's neurological status and final clinical outcomes.