Introduction: Traumatic brain stem lesions (tBSL) in children are thought to be a rare phenomenon. This prospective study analyzed the frequency and significance of such lesions on early magnetic resonance imaging (MRI) after severe head injury, since CT fails to demonstrate these lesions.
Methods: In 30 consecutive children comatose after head injuries, MRI was performed within 8 days of the injury.
Results: The incidence of tBSL was 60%. When the lesion affected the pons or caudal portions of medulla oblongata bilaterally, mortality was 100%. The presence of tBSL significantly correlated with the duration of coma and the categories of outcome, as indicated by the Glasgow Outcome Score. The frequency and the distribution of tBSL in children were similar to adults.
Conclusion: Magnetic resonance imaging appears to be of high predictive value after severe pediatric head injuries.