Central autonomic dysfunction following acquired brain injury in children

This study describes the characteristics of children who had central autonomic dysfunction (CAD) after acquired brain injury. CAD was defined as an unexplained increase in body temperature, blood pressure, or respiratory rate. We surveyed a consecutive series of 220 children who had been unconscious for 24 or more hours after acquired brain injury. Thirty-one children met criteria for CAD by chart review. The development of CAD carried with it serious implications as those children were unconscious longer (median 150 vs. 28 days), had worse cognitive and motor outcomes, and were more likely to die (16 vs. 3.6%). Follow-up neuroimaging studies most commonly showed moderate to severe atrophy and ventricular enlargement. The onset of CAD was usually seen within one month of injury and frequently within one week. All patients required medication to control the symptoms of CAD; nine still required intervention six or more months alter injury. CAD is commonly seen in children with severe brain injury. It complicates the management of these patients, reflects more severe injury, is usually associated with less favorable outcome, and can seriously interfere with rehabilitation programs.