pediatric traumatic brain injury
Introduction
Introduction to pediatric craniocerebral injury Craniocerebralinjury is the most common cause of death and disability in children, because children's nervous system is imperfectly developed, sensitive to injury, and active during childhood, with poor self-protection and vulnerability to accidental injury. damage. Many studies have also shown that in the whole age group, the age of 5 years old is a peak incidence. basic knowledge The proportion of illness: 0.035% Susceptible people: children Mode of infection: non-infectious Complications: cerebral edema, shock, coma, cerebral palsy
Cause
Causes of pediatric craniocerebral injury
(1) Causes of the disease
Main reason
The main cause of brain injury in children is fall, impact, and neonatal brain injury is mainly caused by birth injury.
2. Classification and classification
Classification and classification of brain injury:
(1) Classification: Brain injury can be divided into two categories: primary and secondary.
1 primary brain injury: including concussion, brain contusion, primary brain stem injury, epidural hematoma, subdural hematoma, multiple hematoma or mixed hematoma, intraventricular hemorrhage.
2 secondary brain injury: including brain displacement or cerebral palsy caused by compression injury, diffuse brain swelling and cerebral infarction.
(2) Classification:
1 According to the Gossago coma score classification: According to the post-injury neurological signs (Glasgow coma score) can be divided into 3 types: light (13 ~ 15 points); medium (9 ~ 12 points); heavy (3 to 8 points).
2 According to the degree of damage classification: can also be divided into 4 types:
A. Light: no skull fracture, and loss of consciousness no more than 30min.
B. Medium: fracture of the skull, mild brain contusion, or loss of consciousness after injury for 30min to 12h.
C. Heavy: All intracranial hematoma, brain contusion, brain stem injury, loss of consciousness for more than 12h or increased consciousness disorder.
D. Extraordinary: Deep coma after the injury accompanied by strong brain, double sputum, serious disturbance of vital signs or breathing has stopped.
(two) pathogenesis
Characteristics of children's craniocerebral injury: Children's immature brain structure features play an important role in the immediate effect of trauma. The infant's skull is thin and elastic, the suture is not closed, and it is easy to deform under external force, which can buffer the impact energy. To reduce the accelerated injury, the anterior middle cranial fossa is relatively flat and smooth, and the friction resistance to the moving brain tissue is small, which can reduce the deceleration and the injury. In addition, the subarachnoid space of the child is smaller than that of the adult, and the brain tissue can be active. The amplitude is small, so the brain surface contusion caused by traumatic brain injury in children is less.
However, the structure of the brain in children also has a side effect of aggravating the damage. The scalp between the layers of the scalp is rich in loose blood vessels. After the injury, it can cause extensive scalp hematoma and the hematoma is not easy to self-limiting, often causing hemorrhagic shock. Children with skull fracture and dura mater In the ripper, the fracture line can be progressively widened due to the impact of the brain pulsation, forming a child-specific growth fracture, which can cause bone defects and even form local brain bulging; the blood flow of the brain tissue of the child is larger than that of the adult. The blood vessels on the surface of the brain are dense, and the blood vessels are torn under the external force. The bleeding is fierce. The blood-brain barrier in children is imperfect, the tissue permeability is high, the brain tissue is edematous after trauma, and the swelling is obvious, which often aggravates secondary brain injury.
Prevention
Prevention of pediatric craniocerebral injury
Pay attention to perinatal work, prevent premature birth, difficult birth, improve delivery technology, prevent neonatal brain injury; care for children of all ages to prevent various accidents and brain trauma.
Complication
Complications of brain injury in children Complications, brain edema, shock, coma, cerebral palsy
There are signs of meningeal irritation, cerebral edema, increased intracranial pressure, shock, coma, angulation, cerebral palsy, respiratory and circulatory function failure, seizures, limb paralysis, aphasia and partial sensory disturbances.
Symptom
Symptoms of craniocerebral injury in children Common symptoms Pale muscle tension reduction Meningeal irritation Drowsiness Shortness of breath Consciousness disorder Coma intracranial hemorrhage
Neonatal craniocerebral injury is almost caused by birth injury, mostly due to intracranial hemorrhage caused by skull deformation, and often accompanied by cerebral hypoxia damage, can be expressed as postpartum do not cry, pale, less limb activity, shortness of breath or irregular, Signs of skull deformation, increased stenosis of the cardia, weakening of muscle tension and muscle strength of the limbs, or disappearance of physiological reflexes, due to imperfect development of the nervous system in children, poor stability, so when the brain tissue contusion, serious clinical response, vital signs Disturbing is obvious, prone to shock symptoms, children often have delayed conscious disturbance, that is, the primary coma after the injury is short or absent, but after crying, it falls into a state of drowsiness, which can last for several hours or sleepy for several days, often with Concomitant secondary coma caused by secondary brain injury, children may also have frequent vomiting, headache, seizures, neck stiffness, bilateral pupils or ocular dyskinesia, local brain tissue damage may occur limb paralysis or Convulsions, aphasia and partial sensory disturbances, lumbar puncture, bloody cerebrospinal fluid, meningeal irritation, cerebral edema or swelling in the course of the disease can lead to intracranial Increased, children with changes in vital signs, children with cerebellar incisional hernia and occipital foramen magnum, manifested as deepening of consciousness disorders, paroxysmal angular arch reversal, pupils are not large, light reflection disappears and The failure of respiratory and circulatory function, the clinical manifestations of pediatric intracranial hematoma are mild, and the symptoms of cerebral palsy appear later, but the condition changes rapidly. Once the pupil is dilated, it immediately enters an endangered state.
Examine
Examination of pediatric craniocerebral injury
Lumbar puncture can help to determine whether there is subarachnoid hemorrhage or intracranial hypertension, but should be used with caution to avoid cerebral palsy.
X-ray can be used to determine whether there is a skull fracture; CT can be found in brain contusion, intracranial hematoma, brain swelling and skull fracture, is the most important means of examination.
Diagnosis
Diagnosis and diagnosis of pediatric craniocerebral injury
diagnosis
According to the history of trauma, it is easy to diagnose, 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 condition. The early stage of the brain injury should pay attention to monitoring the life. Signs and signs of neurological symptoms and signs should be reviewed for short-term review of children's state of consciousness, pupillary changes, spontaneous movements and brainstem physiological reflexes, to grasp the development of the disease at any time, and make corresponding diagnosis and treatment.
Differential diagnosis
Have a history of birth injury or trauma, easy to distinguish from other causes of intracranial lesions, laboratory and auxiliary examination results can also help differential diagnosis.
