Influences of developmental age on the resolution of diffuse traumatic intracranial hemorrhage and axonal injury

Dianne Weeks, Sarah Sullivan, Todd Justen Kilbaugh, Colin Smith, Susan S Margulies

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This study investigated the age-dependent injury response of diffuse traumatic axonal injury (TAI) and regional subdural and subarachnoid intracranial hemorrhage (ICH) in two pediatric age groups using a porcine head injury model. N=55 5-day-old and N=40 4-week-old piglets, which developmentally correspond to infants and toddlers respectively, underwent either a sham injury or a single rapid non-impact rotational injury in the sagittal plane and were grouped by post-TBI survival time (sham, 3-8 hours, 1 day, 3-4 days, and 5-6 days). Both age groups exhibited similar initial levels of ICH and a significant reduction of ICH over time (p<0.0001). However, ICH took longer to resolve in the 5-day-old age group. At 5-6 days post-injury ICH in the cerebrum had returned to sham levels in the 4-week-old piglets, while the 5-day-old still had significantly elevated cerebral ICH (p=0.012). Both ages also exhibited similar resolution of axonal injury with a peak in TAI at 1 day post-injury (p<0.03) and significantly elevated levels even at 5-6 days after the injury (p<0.008), which suggests a window of vulnerability to a second insult at one day post-injury that may extend for a prolonged period of time. However, 5-day-old piglets had significantly more TAI than 4-week-olds overall (p=0.016), which presents some evidence for an increased vulnerability to brain injury in this age group. These results provide insight into an optimal window for clinical intervention, the period of increased susceptibility to a second injury, and an age dependency in brain injury tolerance within the pediatric population.
Original languageEnglish
JournalJournal of Neurotrauma
Early online date28 Aug 2013
Publication statusPublished - 2013

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