[MRI findings of closed head injury in children; with special reference to the effect of central shearing force].

It is considered that shearing effect as introduced by Holbourn may produce central concussion, diffuse brain swelling and diffuse axonal injury according to its grade of force. MRI was performed in 38 children who had been admitted to our hospital during the previous 1 year for the treatment of closed head injury of varying severity. In 8 out of 38 cases, abnormal high signal intensity was observed in the medial and para-medial brain parenchyma on MRI. All of these 8 cases suffered from head trauma caused by motor vehicle accidents. They included 2 cases of cerebral concussion, 1 of diffuse brain swelling, and 5 cases of diffuse axonal injury. In 2 cases of cerebral concussion, MRI (T2 weighted) revealed only localized high intensity in the corpus callosum, while CT showed normal and subarachnoid hemorrhage only at the interposium. These two children had been unconscious for periods of 20 to 30 minutes. In one case of diffuse brain swelling, MRI (T2W) showed a slightly obscure border between gray and white matter due to generally increased intensity. In 5 cases of diffuse axonal injury, most of these cases manifested lesions at the corpus callosum, deep white matter, periventricular gray matter, pons, midbrain and the cerebellum as demonstrated by high signal intensity on MRI (T2W) while CT in the acute stage showed small hemorrhage at the corpus callosum, corticomedullary junction and mid-brain and in the ventricles. Among these, two cases also demonstrated subdural hematoma and cortical contusional hemorrhage. At 3-4 weeks after injury, the area of high intensity previously demonstrated in the deep white matter and the corpus callosum on MRI (T2W) was reduced.(ABSTRACT TRUNCATED AT 250 WORDS)

Arachnoid cyst of the quadrigeminal cistern.

The case report of an infant girl with hydrocephalus due to an arachnoid cyst situated at the posterior end of the third ventricle is described. The mechanism of fluid accumulation in the cyst and the choice of surgical treatment are discussed.

[Subdural abscess in infant and child (author's transl].

Two cases of subdural abscess in infant and child treated with irrigation via burr holes were reported. The first case was a 1.4-year-old boy with right hemiparesis and mental retardation since severe head trauma at 9 months old. The patient with manifested with an acute onset of high fever followed by disturbance of consciousness and convulsive seizures 2.5 months prior to admission to our department. During admission in the other hospital, the diagnosis of septicemia caused by E. coli was made by blood cultures when CT scan demonstrated a huge lentiform low density area over the right hemisphere and contralateral crescent low density area. The low density area on the right side was well circumscribed by high density rim which was enhanced by contrast medium. Under the diagnosis of bilateral subdural abscess secondary to septicemia caused by E. coli, irrigation of the purulent cavity was carried out. The contralateral low density area was found to be chronic subdural effusion. The second case of 3-month-old infant who complained of high fever, neck stiffness, unconsciousness and right hemiconvulsions 8 days prior to admission. CT scan showed bilateral crescent low density areas indicating subdural effusion. Subdural punctures performed via the fontanelle revealed pus in the left subdural space and xanthocromic fluid in the right side. The low density area on CT scan was changed to the lentiform high density area circumscribed smooth high density rim during the course of the patient. The subdural abscess was treated with irrigation via burr holes. In this report, the etiology of the subdural abscess and route of infection in addition to follow up study of CT findings were presented with the literature.