Pediatric Concussion
Introduction
Introduction to children's concussion Concussion of bran refers to the transient, reversible brain function loss that can be detected without damage to the brain tissue structure, although the time of loss of consciousness has been defined as "transient", but the exact time There are still controversies in terms of length and length. Some scholars believe that loss of consciousness should last for a few seconds or a few minutes. Most people think that consciousness is lost within half an hour. basic knowledge The proportion of illness: 0.001% Susceptible people: children Mode of infection: non-infectious Complications: headache, insomnia
Cause
Causes of concussion in children
Causes
The head is subject to external forces (78%):
Common causes include head impact by gravity or high-speed shaking; when falling from a height, the feet are first grounded; or the skull fractures cause brain compression caused by the brain.
Pathogenesis
Children's immature brain structural features play an important role in the immediate effects of trauma.
Characteristics of children's brain injury:
1. Infants and young children have thin skull and good elasticity. The suture is not closed. It is easy to deform under the action of external force, which can buffer the energy of impact and reduce the accelerated damage.
2. Because the anterior middle cranial fossa is relatively flat and smooth, and the friction resistance to the moving brain tissue is small, it can reduce the deceleration and the impact injury.
3, the subarachnoid space of children is smaller than that of adults, and the brain tissue can be moved to a small extent, so the brain surface contusion caused by traumatic brain injury in children is less.
4, brain stem conduction axon shear stress damage, pathological manifestations of chromatin dissolution of large neurons in the reticular nucleus of the brainstem and accumulation of glycogen in dendrites.
5, due to imperfect development of blood-brain barrier in children, high permeability of tissue, edema and swelling of brain tissue after trauma, can often aggravate secondary brain injury.
Prevention
Pediatric concussion prevention
1. Care for children of all ages to prevent brain injury such as falling bed and impact.
2. Pay more attention to rest after a concussion. Patients with concussion must pay attention to rest, do not use the brain excessively. If it is a patient with mild symptoms, you can gradually get out of bed. Patients should eat light food.
Complication
Pediatric concussion complications Complications, headache, insomnia
Most patients with concussion sequelae have symptoms that are characterized by headaches. Headaches can be aggravated by brain, reading, vibration, special odor, dirty air, many people, and mental factors. In addition, often accompanied by insomnia, memory loss, inattention, irritability, irritability, slow response to the outside world, as well as dizziness, dizziness, sweating, weakness, palpitation, shortness of breath, nausea.
Symptom
Symptoms of Concussion in Children Common Symptoms Dizziness Retrograde Forgotten Complexion Pale White Susceptibility Drowsiness Headache Blood Pressure Drops Muscle Tension Reduced Disorders
Clinical manifestations:
Patients with concussion are characterized by transient loss of consciousness after trauma. Due to shear stress damage in the brain stem, a large child will have persistent headache, vomiting, dizziness, mental stress, retrograde amnesia after waking. Wait. The pathological manifestation is the chromatin dissolution of large neurons in the reticular nucleus of the brainstem and the accumulation of glycogen in the dendrites.
1. In older children, the clinical manifestations are usually similar to adults:
1, a brief loss of consciousness, accompanied by decreased muscle tone, tendon reflexes active;
2. When the lower brain stem function is inhibited, there may be a disorder of the vascular nerve center and autonomic nervous regulation, which is manifested by a series of reactions such as slow heart rate, decreased blood pressure, pale complexion, cold sweat, and apnea followed by weakness;
3, some children may still have transient blindness.
Second, for infants and young children, its clinical manifestations are:
1, short-term disturbance of consciousness can not be obvious, often only manifested as a short hairpin after trauma, no response to external stimuli, and then resume limb movement;
2, drowsiness, irritability and vomiting;
3, after the concussion of infants and young children, although there may be no changes in pathological structure, but diffuse brain swelling can occur;
4, after the injury, the so-called "pediatric concussion syndrome", that is, neurological deterioration, delayed vomiting and lethargy.
The occurrence of "pediatric concussion syndrome" may be related to the stimulation of vagus nerve by histamine-like neuroactive substances. Delayed symptoms may be due to the fact that such substances are diffused from the lateral ventricle and the third ventricle to the bottom of the fourth ventricle. Unconsciousness of infants and young children may be related to the development of pediatric nervous system, but it is more likely to be related to the injury mechanism. Children's trauma is mostly caused by falling bed. The external force is mostly linear acceleration or deceleration, and the brain stem caused by rotation or shear stress. Less damage.
Examine
Pediatric concussion check
1. Use lumbar puncture to measure whether the cerebrospinal fluid pressure is in the normal range, no abnormal changes in the cerebrospinal fluid, such as red and white blood cells.
2, PET brain metabolism test showed that the brain tissue glucose utilization increased significantly, showing a high metabolic rate change.
3. The micro-determination of neurotransmitters in cerebrospinal fluid can increase the content of neuro-suppressive transmitters such as glutamine.
4. Many enzyme systems that affect axonal conduction or brain cell metabolism can be disordered.
5, X-ray examination of the skull, no concussion in the skull of the concussion patient.
6, EEG examination, visible low or high amplitude fast wave, occasionally diffuse wave and wave, more than 1 to 2 days to return to normal.
7. CT examination, no abnormalities in brain CT scan and enhancement.
8. Single photon emission tomography (SPECT) examination, most of the adolescent patients have decreased blood flow in the cerebellum and occipital lobe.
Diagnosis
Diagnosis and diagnosis of concussion in children
diagnosis
The diagnosis of concussion is based on a history of trauma, loss of transient consciousness, retrograde amnesia, and no positive signs of the nervous system.
1. A transient coma occurs immediately after a head injury. The time is less than 30 minutes. After waking, there are often symptoms such as forgetfulness, headache, dizziness, nausea, anorexia, vomiting, tinnitus, and inattention.
2, blood pressure, breathing and pulse are basically normal.
3. There are no positive signs in the nervous system examination.
4, lumbar puncture examination cerebrospinal fluid pressure and composition of normal.
Differential diagnosis
Rely on a variety of auxiliary examinations and mild brain contusion, cerebral hemorrhage and other identification.
