Abstract
The present case study describes the neurobehavioural, neurodiagnostic, and positron emission tomography (PET) scan findings in a child who sustained a whiplash-type injury in a motor vehicle accident. Although neck and back pain were reported immediately, neurobehavioural symptoms, such as staring spells, gradually increased in frequency over a 2-year period following the accident. At 4 years after the accident the patient's symptoms persisted, as reported by teachers and parents, and more extensive diagnostic work-up was initiated. Standard EEG was normal while two ambulatory EEGs were abnormal and interpreted as epileptiform. A PET scan showed evidence of marked hypometabolism in both temporal lobes. Neuropsychological findings were consistent with PET findings and reflected verbal and visual memory deficits in the context of high average intelligence. Treatment with carbamazepine, verapamil, and fluoxetine greatly improved the patient's symptoms. The present case illustrates an example of a poor outcome in a paediatric case of mild traumatic brain injury, the importance of PET in demonstrating definitive evidence of brain dysfunction, and the child's positive response to anticonvulsant medication.
MeSH terms
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Accidents, Traffic
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Anticonvulsants / therapeutic use
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Antidepressive Agents, Second-Generation / therapeutic use
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Brain Concussion / diagnostic imaging*
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Brain Concussion / drug therapy
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Brain Concussion / physiopathology
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Brain Damage, Chronic / diagnostic imaging*
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Brain Damage, Chronic / drug therapy
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Brain Damage, Chronic / physiopathology
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Carbamazepine / therapeutic use
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Child
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Child Behavior Disorders / diagnostic imaging*
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Child Behavior Disorders / drug therapy
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Child Behavior Disorders / physiopathology
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Electroencephalography / drug effects
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Energy Metabolism / drug effects
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Energy Metabolism / physiology*
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Epilepsy, Post-Traumatic / diagnostic imaging
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Epilepsy, Post-Traumatic / drug therapy
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Epilepsy, Post-Traumatic / physiopathology
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Fluoxetine / therapeutic use
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Follow-Up Studies
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Humans
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Male
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Mental Recall / physiology
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Neurocognitive Disorders / diagnostic imaging*
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Neurocognitive Disorders / drug therapy
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Neurocognitive Disorders / physiopathology
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Neuropsychological Tests
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Temporal Lobe / diagnostic imaging*
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Temporal Lobe / drug effects
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Temporal Lobe / physiopathology
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Tomography, Emission-Computed*
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Vasodilator Agents / therapeutic use
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Verapamil / therapeutic use
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Whiplash Injuries / diagnostic imaging
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Whiplash Injuries / drug therapy
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Whiplash Injuries / physiopathology
Substances
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Anticonvulsants
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Antidepressive Agents, Second-Generation
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Vasodilator Agents
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Fluoxetine
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Carbamazepine
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Verapamil