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Is the Spatial Distribution of Brain Lesions Associated with Closed-Head Injury in Children Predictive of Subsequent Development of Posttraumatic Stress Disorder?¹

¹ From the Division of Neuroradiology, Johns Hopkins Medical Institutions, 600 N Wolfe St, Baltimore, MD 21287-7619 (E.H.H., C.D.); Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, Md (E.H.H.); Department of Psychiatry, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.P.G.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia (R.N.B.). Received August 28, 2001; revision requested October 17; revision received December 21; accepted February 25, 2002. Supported by the Human Brain Project, National Institutes of Health grant R01 AG13743, which is funded by the National Institute of Aging, the National Institute of Mental Health, the National Aeronautics and Space Administration, and the National Cancer Institute. E.H.H. supported by a Richard S. Ross Clinician Scientist Award. The BRAID project is supported by a software grant from Informix. Address correspondence to E.H.H.

PURPOSE: To determine whether there is an association between the spatial distributions of lesions detected at magnetic resonance (MR) imaging of the brain in children, adolescents, and young adults after closed-head injury (CHI) and development of the reexperiencing symptoms of posttraumatic stress disorder (PTSD).

MATERIALS AND METHODS: Data obtained in 94 subjects without a history of PTSD as determined by parental interview were analyzed. MR images were obtained 3 months after CHI. Lesions were manually delineated and registered to the Talairach coordinate system. Mann-Whitney analysis of lesion distribution and PTSD status at 1 year (again, as determined by parental interview) was performed, consisting of an analysis of lesion distribution versus the major symptoms of PTSD: reexperiencing, hyperarousal, and avoidance.

RESULTS: Of the 94 subjects, 41 met the PTSD reexperiencing criterion and nine met all three PTSD criteria. Subjects who met the reexperiencing criterion had fewer lesions in limbic system structures (eg, the cingulum) on the right than did subjects who did not meet this criterion (Mann-Whitney, P = .003).

CONCLUSION: Lesions induced by CHI in the limbic system on the right may inhibit subsequent manifestation of PTSD reexperiencing symptoms in children, adolescents, and young adults.

© RSNA, 2002

Index terms: Brain, injuries, 13.43 • Brain, MR, 13.121411 • Children, central nervous system, 13.43