Computed Tomography in Pediatric Neurologic Disorders
Harvey S. Singer MD1
1 Assistant Professor, Departments of Pediatrics and Neurology, The Johns Hopkins Hospital, Baltimore
The diagnostic approach to neurologic problems in pediatrics has undergone significant change with the introduction of cerebral computed tomography (CT). This roentgenologic procedure based upon the detection of differences in tissue radiodensity,1-4 has become the dominant diagnostic tool in the evaluation of intracranial pathology. The technique is safe, rapid, easy to repeat, and involves low radiation exposure (about equal to a skull radiogram). It demonstrates the outline and size of the ventricles and subarachnoid spaces, the cerebral parenchyma, and pathology which produces alterations in x-ray penetration (Fig 1). The ability of the CT scan to delineate abnormalities accurately has markedly reduced the indications for more invasive studies such as cerebral angiography and pneumoencephalography.
ACUTE NEUROLOGIC PROBLEMS
The CT scan can be extremely valuable in establishing the underlying intracranial pathology in pediatric patients who are experiencing the acute onset of neurologic symptomatology. Generally included in the differential diagnosis are conditions such as trauma, tumors, infections, and stroke-like syndromes.
Head Trauma
The majority of children with minor head trauma show progressive improvement in their level of consciousness during the first 24 hours following injury and no neurodiagnostic procedures are indicated. However, radiologic evaluation is required in more severely injured children, especially those showing neurologic deterioration or prolonged loss of consciousness and for whom there exists the possibility of an epidural or subdural hemorrhage, intracerebral hematoma, or cerebral edema.
