Clinical characteristics of infantile traumatic brain injury with a biphasic clinical course and late reduced diffusion among pediatric patients with traumatic brain injury.

Background: Infantile traumatic brain injury with a biphasic clinical course and late reduced diffusion (TBIRD) is a condition resembling acute encephalopathy with biphasic seizures and late reduced diffusion, marked by a bright tree appearance and potential sequelae. Although seizures are common in pediatric traumatic brain injury (TBI), distinguishing TBIRD from other seizure etiologies is crucial. This study compared the clinical characteristics of patients with traumatic brain injury (TBI), including those with and without seizures, identified TBIRD cases, and examined their distinguishing features.

Methods: Data from pediatric patients with traumatic brain injury (TBI) admitted to our pediatric intensive care unit between March 2016 and July 2023 were analyzed. Patients were divided into two groups: seizure and non-seizure. Clinical features were compared, and TBIRD cases were identified within the seizure group for analysis.

Results: Among the 104 patients, 28 experienced seizures, while 76 did not. The seizure group was significantly younger and had a higher prevalence of subdural hematomas (SDHs), which were strongly associated with seizures (dds ratio OR = 6.73, 95%: 1.99-22.8, P = 0.00216). Of the 28 seizure patients, five were diagnosed with TBIRD, all of whom presented with SDH and status epilepticus. TBIRD was absent in the patients without SDH. Status epilepticus was significantly more common in TBIRD cases than in non-TBIRD cases.

Conclusion: This study suggests that seizures, a hallmark of TBIRD, are strongly associated with subdural hematoma (SDH). All TBIRD cases involved SDH and status epilepticus, whereas none of the TBIRD cases occurred without SDH. TBI patients with SDH and status epilepticus require careful management because of the risk of developing TBIRD.