Cerebral white matter lacerations in children caused by repetitive head trauma

Abstract

It has been known that infants less than 1 year develop cerebral white matter (WM) lacerations associated with head trauma, however, there has been no report of similar WM lesions over 1 year. We report three teenage boys (11, 12, and 18 years at final MRI studies) with acquired WM lacerations associated with recurrent head trauma who developed neurologic symptoms such as spastic paralysis, afebrile convulsions, and cognitive impairment. Two of them (patients 1 and 2) were given a diagnosis of autism spectrum disorder and had a history of repeated severe self-inflicted head trauma from preschool age. Patient 3, who practiced karate and boxing from preschool age, showed gradual declining intellectual ability. Brain MRI of the three patients revealed severe lacerations in the bilateral cerebral WM. Previous neuroimaging showed no WM lacerations at 4 and 5 years in patients 1 and 2, or mild WM lacerations at 17 years in patient 3, indicating the WM lacerations could have been acquired in childhood. It is suggested that repetition of head trauma in children can cause cerebral WM lacerations and brain dysfunction.

Introduction

Cerebral white matter (WM) lacerations associated with head trauma have been reported in infants less than 1 year [1], [2]. WM lacerations are observed in the unmyelinated WM in early infancy, while patients older than 1 year show traumatic WM injury that is very similar to that observed in adults, such as diffuse axonal injury, callosal injury, and parenchymal hemorrhage [3], [4]. It is considered that the poorly myelinated infantile WM with a gelatin-like consistency, the very pliant skull with non-fused sutures, and the shallowness of the subarachnoid space predispose to parenchymal lacerations in the context of shear force generated from trauma [2], [5]. WM lacerations have only been observed in young infants with abusive head trauma (AHT), i.e., never with accidental head injury, leading to the concept that WM lacerations may represent a pattern of injury unique to AHT [1]. We first report three teenagers with severe WM lacerations which could be associated with repetitive impacts to their heads.