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Understanding head injuries

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January 18, 2017

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Comments

Frank
January 23, 2017

I thought that concussions are seen using MRI imaging (as Dr Amen on PBS ca 2002 was doing).

Jonathan Nadler, MD
January 24, 2017

Traditional MRIs cannot visualize concussions. Newer, more complicated forms of functional MRIs can differentiate some findings, but are mostly being used for research.

I cannot speak to the exact practice patterns of neurologists, but generally these advanced imaging tests are not being used in the diagnosis or treatment of concussions. In the future, as the technology improves, they possibly could play a role. However, for now, they are not routinely being ordered, and certainly not from the Emergency Department.

Roslyn Richter
January 23, 2017

how about frequency of head falls taken by very young children 2,3 and 4 years old( while running , jumping , climbing and playing with others?

Jonathan Nadler, MD
January 24, 2017

Great question Roslyn. We see many toddlers with falls, and very few of them have serious injury, however their age makes history taking and examination more difficult. This was well studied through the PECARN group (Pediatric Emergency Care Applied Research Network) who published a set of guidelines used by most emergency physicians.

The paper can be seen here: http://www.pecarn.org/documents/kuppermann_2009_the-lancet.pdf

The easier to navigate rules can be viewed here:
https://www.mdcalc.com/pecarn-pediatric-head-injury-trauma-algorithm

Certain injuries and examination findings make children high risk, and they do require imaging. However, for most children, a brief period of observation (about 4 hours) can help reassure physicians that there are no significant injuries.

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