Pediatric brain contusion
Introduction
Introduction to brain contusion and laceration in children Contusion and laceration of the brain is a serious closed brain injury that causes the brain tissue to slide and collide in the cranial cavity. The deformation and shear stress of the brain tissue cause contusion and punctiform hemorrhage on the surface of the brain tissue. When the injury is serious, the gray matter of the brain may be torn, and the brain laceration is formed. The brain contusion and laceration is rare in infants and young children, but it occurs mostly in the older children whose brain is basically mature, mainly because the skull of the infant is flexible. The elasticity is good to buffer the impact of the outside world. The subarachnoid stenosis restricts the violent movement of the brain tissue. The anterior middle cranial fossa is smooth and the collision force on the brain tissue is light. In general, the incidence of brain contusion and laceration is much lower in children because the inner plate of the skull is smoother than the adult and the brain tissue is better. basic knowledge The proportion of illness: 0.035% Susceptible people: children Mode of infection: non-infectious Complications: aspiration pneumonia dehydration electrolyte disorder epilepsy
Cause
Causes of brain contusion and laceration in children
Damage to the basal ganglia (30%):
Infantile blunt trauma can only cause damage to the basal ganglia without significant cerebral cortical injury, and the clinical manifestation is contralateral hemiplegia. According to Maki et al. (1980), it is mainly that children's rotational movement of brain tissue during a fall injury leads to the traction of the lateral branch of the middle cerebral artery. The displacement of the blood vessel will cause infarction bleeding in the bottom node of the blood supply.
Extensive laceration of white matter (30%):
Infants and children with brain contusion and laceration are more common in the frontal lobe and temporal lobe, often manifested as extensive laceration of the white matter in the injured area. White matter tears often form many small and irregular cavities, but the bleeding is mild.
Brain swelling is more pronounced (30%):
The response of children's brain tissue to contusion is that the brain swelling is more obvious, and the cause of brain swelling is often caused by vasodilation and increased cerebral blood flow, not caused by edema.
Pathological change
First, according to the degree of performance:
(1) Light can be seen on the surface of the frontal sacral leaf, congestion, edema, a little flaky hemorrhage under the soft membrane, arachnoid and soft membrane often have a cleft, cerebrospinal fluid is bloody.
(2) Severe cerebral cortex and white matter under the white matter, rupture, local hemorrhage, edema, small blood vessel embolism, brain tissue erosion and necrosis, surrounded by a few pieces of hemorrhage and softening, a wedge-shaped deep white matter.
Second, according to time performance:
(1) Proliferation and infiltration of astrocytes and microglia appeared around the cleft after 36 h.
(2) After 4 to 5 days, the necrotic tissue is liquefied, the blood cells are dissolved, and the surrounding brain tissue contains hemosiderin.
(3) 1 to 3 weeks after injury, the local necrotic liquefaction area cystic absorption, peripheral glial cell hyperplasia, arachnoid thickening and brain tissue adhesion, and finally the formation of glial scar.
(4) Fissure of the fissure cavity around 26 days.
In the early stage of infant brain contusion and laceration, small clefts in the white matter area of the injured area are accompanied by a small amount of hemorrhage. The laceration is usually distributed along the cerebral palsy, parallel to the surface of the cortex, and there is little bleeding in the cleft, which does not produce a mass effect. .
Prevention
Prevention of brain contusion and laceration in children
Pay attention to perinatal health care, prevent premature birth, dystocia; improve delivery technology, prevent neonatal brain injury; care for children of all ages, prevent brain trauma and various accidents.
Complication
Complications of brain contusion and laceration in children Complications, aspiration pneumonia, dehydration, electrolyte disorder, epilepsy
Frequent vomiting can also cause severe dehydration and electrolyte imbalance in children, leading to epilepsy, etc. due to accidental attraction of asphyxia or aspiration pneumonia.
Symptom
Symptoms of brain contusion and laceration in children Common symptoms Irritability, irritability, nausea and vomiting, coma, meningeal irritation, disturbance of consciousness, dehydration, sensory disturbance, hemianopia
1. Consciousness disorder: In addition to the diffuse contusion of the cerebral cortex, brain contusion and laceration combined with brain stem network structure damage, so consciousness disorder is one of its most prominent clinical manifestations, and many coma immediately after injury, due to injury The degree and location of the coma range from minutes to hours, days or prolonged coma.
2. Symptoms of focal nerve injury: The location of the contusion and laceration varies, and when the injury is located at the front of the frontal lobe, there may be no loss of focal neurological function; if the cortical functional area is damaged, more than the injury Immediately after the emergence of the corresponding limb paralysis, partial sensory disturbance, aphasia or hemianopia.
3. Headache: Subarachnoid hemorrhage caused by brain contusion and laceration, cerebral edema and brain swelling can cause severe headache. The nature is mostly pain or pain. When the child can not express pain, it is often expressed as crying and irritability. , easy to provoke and so on.
4. Seizures: Children often have epilepsy in the early stage of contusion, usually in a few hours or days after the injury, with major seizures and localized seizures, mainly due to imperfect development of the inhibitory function of the cerebral cortex in children. More sensitive to damage.
5. Nausea, vomiting: stimulation of subarachnoid hemorrhage during brain contusion, changes in intracranial pressure, cerebrospinal fluid impact on the ventricle of the fourth ventricle can cause excitement in the medullary vomiting center, resulting in frequent ejection immediately after injury Vomiting is especially common in children. Children with coma can be suffocated or inhaled pneumonia by mistake. Frequent vomiting can also cause severe dehydration and electrolyte imbalance in children.
6. Meningeal irritation symptoms: Subarachnoid hemorrhage caused by contusion and laceration stimulates the dura mater, causing men with cervical stiffness, positive leg flexion test and other meningeal irritation.
7. Others: In children with brain contusion, elevated body temperature is also one of the common symptoms, which is related to the instability of the hypothalamic body temperature regulation in children, sensitive to injury and bloody cerebrospinal fluid stimulation.
Examine
Examination of brain contusion and laceration in children
Lumbar puncture examination, because of subarachnoid hemorrhage, cerebrospinal fluid is usually homogeneous blood, this point can be distinguished from concussion; lumbar puncture can also measure intracranial pressure and drainage of cerebrospinal fluid, but for patients with intracranial hypertension should be listed as Taboo.
1. Skull X-ray film: It is helpful to find skull fractures, and it also has a certain effect on understanding the mechanism of injury and judging the injury.
2. CT: typical manifestations of low-density cerebral edema in the area of scattered scattered high-density small hemorrhagic foci, part of which can be fused to form a small blood clot in the brain, the surrounding edema is obvious, CT can not only brain contusion The location, extent and presence or absence of secondary injury can be accurately judged. Indirect estimation of intracranial pressure can also be made according to the displacement of the midline structure and the size of the ventricle. The short-term CT review can also help to observe cerebral edema. The evolution or the occurrence of delayed hematoma is therefore the preferred adjuvant test for brain contusion.
3. MRI: generally not the first choice for acute craniocerebral injury, but MRI is superior to CT in small contusion, diffuse axonal injury and early infarction in the brainstem.
Diagnosis
Diagnosis and diagnosis of brain contusion and laceration in children
diagnosis
Severe closed head injury, deep post-injury consciousness, long duration, headache, frequent vomiting, accompanied by focal neurological dysfunction and meningeal irritation, lumbar puncture with bloody cerebrospinal fluid can confirm brain contusion A laceration, but often requires an auxiliary examination such as CT to rule out an intracranial hematoma.
Differential diagnosis
In addition to the identification of intracranial hematoma, brain CT and other auxiliary examinations should be performed in time.
