Veek, E.M.J. van der (2012) The juvenile head trauma syndrome. thesis, Medicine.
Full text available on request.Abstract
Background: The juvenile head trauma syndrome (JHTS) describes a clinical event with neurological deterioration, which is sometimes seen in children after a mild head trauma. The underlying mechanism of the JHTS is still uncertain. It has been suggested that there is a role for cortical spreading depression (CSD), a phenomenon which is assumed to be an important part of the pathophysiology of migraine. Hypothesis: We postulate that children affected by the JHTS are more susceptible to CSD, which may be caused by a genetic aetiology similar to that causing migraine. Objectives: Our first purpose was to describe a research population consisting of children with the JHTS, focusing on age, clinical symptoms, the course of the syndrome, and possible abnormalities in imaging data. A second aim of the study was to demonstrate a relationship between the JHTS and migraine. Study design: A descriptive study with a case-control-family design. Methods: We performed a retrospective data search with DBC codes to select children with the JHTS. We evaluated these cases by means of a questionnaire, a screening neurological physical examination and a reassessment of diagnostic imaging data. The relationship with migraine was analysed by means of a case-control-family design. Results: We included thirty-seven patients with the JHTS who were seen at the emergency departments of the MST in Enschede or the Isala klinieken in Zwolle between 01-01-2008 and 01-07-2012. They accounted for approximately 2,8% of the total number of children seen at the emergency department with a mild head injury. Twenty-four of the patients were boys and thirteen were girls. The median age of the research population was seven with a range between two and seventeen years. We found a median duration of the lucid interval of 22,5 minutes and a median total duration of 7,5 hours. Thirteen patients experienced loss of consciousness with a median duration of forty-five minutes. None of the thirty-seven patients met the criteria for migraine. However, 44,4% of the patients had a first-degree relative with a positive history of migraine, and 61,1% of the patients had a first- and/or second-degree relative with a positive history of migraine. With a case-control-family design we found a significant difference in the proportion of patients with a positive family history of migraine between our case group and our control group. We found this significant difference for first-degree relatives (p = 0,016 with an OR of 2,4) as well as first- and/or second-degree relatives (p = 0,000 with an OR of 3,6). The reassessment of the diagnostic imaging data showed no abnormalities. Conclusion: The JHTS is a relatively rare phenomenon, which was seen in approximately 2,8% of all children who were seen at the emergency department with a mild brain injury. The JHTS can occur in children at all ages and has a large variety of clinical symptoms and a widely ranged course. There is no evident relationship between the JHTS and migraine in the research group. By contrast, there is a significant relationship between the JHTS and a positive history of migraine in first- and second-degree relatives. To further analyse this relationship follow-up studies are necessary, including genetic research
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Hgeman, dr. G. and Neurologist and -Medisch Spectrum Twente Enschede and -Isala klinieken Zwolle |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:01 |
| Last Modified: | 25 Jun 2020 11:01 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2165 |
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