What Are the Most Common Causes of Traumatic Brain Injury in Children?

Craniocerebral injury is the most common cause of death and disability in children. Childhood activities, poor self-protection ability, vulnerable to accidental injury, resulting in craniocerebral injury, within 5 years of age is the peak period.

Basic Information

Visiting department: neurosurgery
Multiple groups: Children
Common locations: Brain
Common causes: The main cause of craniocerebral injury in children is fall and impact, and craniocerebral injury in newborns is mainly caused by birth injury.

Common symptoms: It is characterized by not crying postpartum, pale, low limb movements, shortness of breath or irregularity, signs of skull deformation, increased cardia tension, poor pulsation, weakening of limb muscle tension and muscle strength, or disappearance of physiological reflexes, etc.
Contagious: no

Causes of craniocerebral injury in children

The main cause of craniocerebral injury in children is fall and impact, and craniocerebral injury in newborns is mainly caused by birth injury.

Clinical manifestations of craniocerebral injury in children

Neonatal craniocerebral injuries are almost all caused by birth injuries, mostly caused by intracranial hemorrhage due to skull deformation, and often accompanied by cerebral hypoxia damage, which can be manifested as not crying postpartum, pale, less extremities, shortness of breath or irregular, Signs include skull deformation, increased cardia tension, poor pulsation, weakened limb muscle tension and muscle strength, or disappearance of physiological reflexes.

Due to the imperfect development of the nervous system and poor stability in children, when the brain tissue is contused, the clinical response is severe, the vital signs are disordered, and the symptoms of shock are prone to occur. Children often have delayed conscious disturbance, that is, primary coma after injury. Short or absent, but crying soon after falling into a lethargic state, which can last for several hours or lethargy for several days. It is often confused with secondary coma caused by secondary brain injury. Children may also experience frequent vomiting, headache, and epilepsy. Seizures, stiff neck, unequal pupils on both sides or dyskinesia of the eye muscles.

Paralysis or convulsions, aphasia, and sensory disability can occur when local brain tissue is damaged. Lumbar puncture often has bloody cerebrospinal fluid, meningeal irritation signs, and cerebral edema or swelling can lead to increased intracranial pressure during the course of the disease. Children show signs of vital signs and cerebellar notch hernia and foramen magnum , Manifested by the deepening of consciousness disturbance, paroxysmal angle arch, pupils ranging in size, disappearance of light reflection and failure of respiratory circulation function, the clinical manifestations of intracranial hematoma in children are milder, the symptoms of cerebral hernia appear later, but the condition The changes are rapid. Once the pupils dilate, they quickly enter an endangered state.

Pediatric craniocerebral injury examination

1.CT

Pathological changes such as skull fractures, intracerebral hematomas, cerebral edema, brain swelling, and brain contusion can be found, which is the first choice for examination.

2.X-ray plain film

Can be judged with or without skull fracture.

3.MRI examination

Can cooperate with CT examination.

4. Lumbar puncture

It is helpful to determine whether there is subarachnoid hemorrhage or cranial hypertension, but it should be used with caution to avoid inducing cerebral hernia.

Diagnosis of craniocerebral injury in children

It is easy to diagnose based on the history of trauma, but to judge the severity of the disease, the scope and type of injury, whether there is hematoma formation and secondary injury, it is still necessary to judge the results of the auxiliary examination and the change of the disease. In the early stage of craniocerebral injury, attention should be paid to monitoring the changes of vital signs and neurological symptoms and signs. The children's consciousness, pupil changes, spontaneous exercise and physiological reflexes of the brain stem should be rechecked in a short period of time to keep abreast of the development of the disease and make corresponding diagnosis deal with.

Pediatric craniocerebral injury treatment

For children with severe craniocerebral injury, we must first maintain the airway patency and the stability of circulatory function, and early correct hemorrhagic shock and pulmonary hypoventilation. The treatment of brain injury should focus on controlling the increase of intracranial pressure, and if necessary, intracranial Continuous monitoring of blood pressure. For those with increased intracranial pressure caused by severely contused brain tissue and intracranial hematomas with space-occupying effects, hematomas should be removed as soon as possible by surgery. Measures to reduce intracranial pressure can be reduced by using excessive ventilation. Partial pressure of carbon dioxide can be achieved, osmotic diuretics and hormone therapy can be applied when ineffective, artificial hibernation therapy and mild hypothermia technology can reduce cerebral metabolic rate, reduce intracranial pressure, children with severe craniocerebral injury can try it, due to pediatric maintenance Water and electrolyte balance function is weak, so while dehydration treatment, we must pay attention to prevention and treatment of hyponatremia, hypokalemia, metabolic acidosis and excessive dehydration.

In general, 2 to 4 days after brain trauma, water retention is often caused by inappropriate antidiuretic hormone secretion syndrome, which is manifested as dilute hyponatremia. At this time, the plasma osmotic pressure decreases, and the intracellular osmotic pressure of brain cells is higher than that of cells. External osmotic pressure, prone to intracellular cerebral edema, if a large amount of infusion at the early stage of trauma may increase the risk of intracranial pressure, the amount of fluid replacement for children with acute cerebral edema should be: 30 ~ 60ml / (kg · d) (older children) , Or 50 100ml / (kg · d) (infants and young children), pure sugar solution is not suitable. Alkaline saline solution can be used to correct the metabolic acidosis often associated with cerebral edema. It must be used for epilepsy after traumatic brain injury. For timely control, diazepam can be used for intravenous infusion. Avoid simultaneous use with phenobarbital (lumina) to avoid causing respiratory depression.

For children with coma at the time of treatment, pay attention to whether there is a combined injury of other organs and spinal cord while dealing with craniocerebral trauma, so as to avoid unnecessary injuries due to delayed treatment.

For children with mild closed head injury who have a transient conscious disturbance, the condition should be closely observed. Once the conscious disturbance deepens and the pupils are not large, CT examination should be performed urgently to deal with it accordingly.