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Advanced Neurology Cognition in children with mild TBI

Collectively, these data indicate that both short- and modalities such as functional MRI and diffusion tensor
long-term memory, visual–constructional skills, and face imaging. These changes include widespread gray and
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affect recognition represent functions at greater risk for white matter losses, which may alter the white matter
children’s regular neurodevelopment after mTBI. organization. The CC is particularly vulnerable to this
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type of injury. This is because transverse forces occurring
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4.3. Cognitive functioning in the monocentric study during TBI may strain the falx cerebri and exacerbate the
According to our study results, intellectual functioning was underlying CC. 71
not affected in children with mTBI during the follow-up, Advanced neuroimaging examinations are currently
as indicated by no significant difference in FSIQ scores limited to research studies, and robust evidence is required
compared with the normal reference values. This finding is for any future clinical application. 72,73 Moreover, during
similar to those reported in adults, in whom the IQ usually the follow-up period, children underwent MRI only on
remains intact post-injury, but differs from those reported the basis of the clinical symptoms. There is no standard
in younger children. 52,62 The study on the long-term protocol regarding the optimal time for performing
consequences of TBI in early childhood demonstrated the neuroimaging studies. According to our retrospective
persistent impact of TBI on IQ, even 10 years after the injury, study, MRIs are usually performed immediately after
in patients with a history of severe TBI that had occurred (T0) or 6 months after (T1) the traumatic event. This
before the age of 7 years. This finding may support the may have introduced a bias because post-TBI structural
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concept of the “double hazard model,” which is based on abnormalities may develop later.
the hypothesis of an interaction between age at injury and
injury severity. 63-65 However, due to the specificity of our 4.6. Study limitations
sample (which included only patients with mTBI) and the The current study had several limitations. First, the
limited size of our study population, the results could not small sample size, even if powered for statistical analysis,
be stratified and corrected for age or other variables. prevented us from performing an advanced stratified
4.4. Emotional and behavioral assessment in the analysis according to age and other baseline factors. The
monocentric study small sample size might have particularly affected the
results of discriminant analyses. However, all patients were
Contradictory to previous studies, the current study accurately and extensively assessed using a wide range of
findings showed no difference in CBCL scores over time. 34,39 cognitive and neuropsychological items, enabling us to
This may be attributable to the following: (1) exclusion of obtain several measures on multiple cognitive domains.
patients with a former diagnosis of neurodevelopmental
disorder from the final analysis and (2) inclusion of The absence of baseline neurocognitive data did not
only three children aged <7 years in the study. Previous allow us to verify possible pre-existing mental conditions.
studies have demonstrated that the long-term difficulties We tried to control this bias by excluding all patients
highlighted by the CBCL are often prevalent in children diagnosed with a neurodevelopmental disorder.
with a history of severe injury at an early age or pre-
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existing attention-deficit hyperactivity disorder. 66 5. Conclusion
Two of the eight study patients exhibited moderately Children who experience mTBI may exhibit subtle memory
high scores on the T0 internalization index, which and visual–constructional impairments and difficulties in
normalized at the T1 follow-up. This reduction in social perception during the follow-up period. Our results
the internalization index may be attributable to the demonstrate the importance of a comprehensive and long-
development of disinhibition following a TBI with a frontal term neuropsychological assessment, including memory
impact. assessment, to plan adequate and timely rehabilitation
programs and school adaptations. Our study findings also
4.5. Neuroradiological examination in the demonstrated that psychiatric disorders are frequently
monocentric study newly diagnosed in the follow-up period and associated
with significant deficits in adaptive functioning, especially
Conventional neuroradiological examinations performed in children with pre-injury psychosocial risk factors.
in the follow-up period did not exhibit a predictive value
for cognitive outcome. However, it is largely recognized Conventional neuroradiological examinations did not
that white matter pathologies in TBI cannot be adequately exhibit a predictive value for cognitive outcome. Thus,
visualized using standard MRI or CT. Specific long- advanced imaging techniques should be performed in these
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term neuroanatomical changes have been documented children to identify specific neuroimaging biomarkers to
in pediatric patients with mTBI using advanced imaging help tailor supportive interventions. Prospective cohort

Volume 3 Issue 4 (2024) 18 doi: 10.36922/an.3886