It is difficult to overestimate the severity of craniocerebral injuries. Among the reasons for patients to turn to medical organizations, traumatic brain injuries in a child occupy leading positions. Such damage in children is a very common occurrence, while cases of household injuries predominate.
Often after a traumatic brain injury in a child and subsequent recovery, complications such as memory impairment, as well as motor activity, can develop.
Causes of occurrence
What can cause such damage? The causes of traumatic brain injury in a child can be a variety of factors. Among young children, these injuries occur due to inattention of parents, for example, as a result of falling out of bed or changing table. Household traumatic brain injuries in a child, injuries sustained at home, on the street and sports, prevail in older children. Boys are injured more often than girls.
At an older age (after 10 years), household factors for the occurrence of head injury are less likely to occur, but the likelihood of developing pathology in road accidents increases.
The prognosis of such an injury depends on the severity of the condition and the timeliness of medical care in the hospital and at the scene. Often the first may cause some difficulties, because in some cases the symptoms of traumatic brain injury in a closed child develop gradually.
If you suspect an injury, children must be sent to specialized hospitals in order to conduct a comprehensive examination and necessary treatment.
Damage classification
Injuries can be divided into open (with damage to the meninges) and closed craniocerebral injuries in children (if it is safe).
In the first case, the wound can be penetrating into the cranial cavity, as well as non-penetrating.
With a closed traumatic brain injury in a child, the symptoms are completely absent, in addition to small abrasions, scratches. Damage in this case is divided into frequent types of head injury:
- Compression of brain structures.
- Concussion.
- Injury.
Despite the classification, the manifestations have very similar features.
From practice, it is clear that cases of children going to hospitals with bruises or concussions of the brain in moderate or mild severity predominate.
Overall picture
What are the features of traumatic brain injury in children? Key points in the development of pathology:
- The defeat of the cranial plexuses of the nerves.
- Focal symptoms.
- Stupefaction.
In case of damage in childhood, there is an almost complete absence of symptoms even after a couple of hours. This makes it difficult to diagnose and help the victims.
Symptoms of a closed craniocerebral injury in a child also have their own characteristics, which are rare in an adult. This is due to age-related changes - immaturity of brain tissue, incomplete ossification of the cranial bone.
With a closed or open traumatic brain injury, the affected child does not have an adequate response to the survey; it is very difficult for him to describe the cause and circumstances of this traumatic injury. In children, in almost 90% of cases, consciousness is lost. In a number of episodes, increased sensitivity to the stimulus (light, sound) may be observed. Neurological signs develop rapidly, cerebral symptoms predominate (vomiting, pain). Young children often develop hemorrhages, and in the future, edema of the whole brain, which leads to serious complications.
Pain in the head is observed in 100% of cases. It worries all children who have suffered injuries of various degrees of severity. In this case, the characteristic of pain is as follows: spilled, completely at rest.
Vomiting is a more common symptom related to cerebral manifestations of TBI due to irritation of the nuclei of nerves located in the structure of the brain. With light damage, vomiting appears with dizziness and pain. If the child is in a serious condition, indomitable vomiting may develop, which does not bring the desired relief.
During the examination of the child, one should pay attention to the reaction of the pupil to light or other irritants. In the case of a mild TBI, disorders appear that are manifested by minor reflexes to a light stimulus (the pupil narrows slowly). In a coma, there are often no reactions to a light stimulus at all.
The detection of one dilated pupil is a formidable symptom of a developing complication of trauma: dislocation (displacement) of the brain into the occipital large opening, compression of the nerve pathways.
The frequency of heart contractions in mild TBI is in the limit of acceptable values, with the most severe injuries, the pulse quickens or decreases significantly. Body temperature is almost unchanged. In a small child, it may increase slightly. If it reaches 41 0 C, intracranial hemorrhage and rapid development of intracranial complications should be suspected.
The listed signs of traumatic brain injury in a child are characterized by variability and can be observed in various combinations.
Concussion
Concussion is the most mild lesion in traumatic brain injury. In this case, no changes are observed in the cerebrospinal fluid; accordingly, there are no external deformations of the bones of the skull, or violations of the integrity of the lining of the brain. If the integrity of the cranium is damaged, then it will not be a concussion, but a bruise.
Symptoms and signs of concussion
With a concussion, loss of consciousness is rare and refers to casuistry. But if this happens, it is rapidly developing and quickly passes completely. After the child wakes up, for some time he will still be in a state of a certain stunning: he cannot understand what happened, where he is. Infant babies cry loudly, twitch convulsively, and it is difficult for parents to calm them in this state. But after some time the children fall asleep. However, after waking up they refuse food, cry and act up. Then the condition normalizes, and then the so-called false recovery occurs.
Cerebral symptoms are presented in the form of vomiting and dizziness. Vomiting occurs at different ages of the patient, and in infants it is characterized by very frequent spitting up. Headaches are not intense, disappear with time at rest, do not require the use of any painkillers. The duration of pain is different, usually from 1 to 3 days.
The classic symptoms of concussion are:
- Decreased reflexes.
- Deterioration of the reaction of the pupils to a light stimulus.
- Muscle contraction.
- Paresis, pronounced disturbances regarding the innervation of facial muscles. A deviation of the tongue to the side may occur.
The above symptoms may not all develop immediately. Sometimes a completely asymptomatic concussion or an erased clinical picture of the injury is also possible. Reliable for the diagnosis are instrumental, laboratory studies.
All symptoms disappear by the end of the week. But the general well-being of the child comes back to normal much earlier. It is important to remember that you should not neglect bed rest, as early rising, active games in the absence of a full recovery can cause complications.
Bruises
This is the name for a very severe damage that develops when the substance of the brain is deformed. Foci can be single or multiple - classified by the depth of the lesion and localization on the cortex.
A mild degree is difficult to differentiate from a concussion, which is why a number of experts consider these two pathologies absolute synonyms. A lesion forms in the brain that does not penetrate into the deep layer of the cortex.
During a moderate bruise, it spreads to the largest surface, but the membrane of the brain is not disturbed.
In severe cases, bruises are characterized by multiple foci or one, however, occupying a large surface of the cortex. The soft membranes of the brain are destroyed. Quite serious complications often develop, since there is a dislocation of the brain, deformation of the trunk.
In the zone of foci of hemorrhage, microcirculation begins to be disturbed, which will lead to the formation of a characteristic clinical picture. In the case of multiple injuries, the condition of the child will be difficult, sometimes incompatible with life.
Symptoms of injury
Tissue hypoxia begins to develop, as well as cerebral edema, some functions of systems and organs are violated. In the case of head injury, focal symptoms will be observed in children: impaired innervation of the facial nerve, paresis, paralysis, dissociation of reflexes, severe pathological disturbances in breathing, as well as heart function. However, it is worth noting that in the case of development of changes in motor activity, there is a great chance of restoration of function, but provided that therapy and timely surgical treatment have been carried out.
Symptoms of injury are most often manifested in the form of pain in the head, frequent vomiting, impaired consciousness and dizziness. However, the signs are more pronounced than with a concussion. Loss of consciousness occurs suddenly, with a longer duration. When waking up, the child is inhibited, unable to adequately talk, and also to assess the state, or tearful, is capricious. Vomiting is indomitable, repeated, does not bring relief and occurs when the head is turned. Pain in the head is observed at almost all stages of the disease, pronounced.
With a bruise of the brain, a rupture of the membrane, bleeding appears. The more pronounced they are, the deeper the damage to the structures of the brain. A large number of red blood cells are found in the cerebrospinal fluid. Blood entering the cerebrospinal fluid leads to irritation of the lining of the brain. This also entails the development of meningeal syndrome. In some groups of babies, the manifestations of this syndrome may be completely absent.
When the focus of TBI in babies in the brain stem is localized, the clinical picture will be characterized by a rare heartbeat and respiratory rate, a rapid decrease in blood pressure, and the body temperature will fall below normal.
In recent years, a new type of damage, called diffuse axonal, has been identified. It occurs during an accident with a sharp braking of a body moving forward. Microtraumas of the brain trunks, as well as nerve bundles, micro-hemorrhages appear in the core of the brain. Young patients have a serious condition, sometimes a coma, which often even leads to death. The difficulty of diagnosis lies in the fact that on CT and MRI it is extremely difficult to notice a similar pathology. Therefore, the diagnosis is established depending on the data after pathological autopsy.
Treatment
Treatment of traumatic brain injury should be carried out depending on the severity. Concussion therapy is also possible on an outpatient basis, that is, at home. The most serious pathologies require qualified care in a hospital. The bulk of young patients are treated in surgical or trauma departments (rarely in neurosurgery).
Treating a child’s head injury in the form of a concussion requires rest. Assign bed rest for about a week. However, reading in bed, playing computer and watching TV should be ruled out. Drug therapy is limited to the use of “Phenobarbital” or “Diphenhydramine”, vasodilator drugs (“Trental”). In a hospital setting, therapy is continued for 2 weeks. After the child is discharged, he is exempted from school at the same time. Therapy is continued for about a month. In nutrition, preference should be given to foods rich in vitamins and minerals. For a while, it is better to abandon salty, as well as spicy foods.
The most mild brain injury should be treated in the same way as a simple concussion, however, the hospitalization period, the duration of bed rest are increased. In the hospital stay - 21 days, and bed rest - at least 2 weeks. Home therapy lasts a month after discharge. Medication includes the use of "Phenobarbital", "Diphenhydramine", nootropics ("Piracetam"), vitamins of group B.
In case of a brain contusion, specialized assistance and surgical treatment are urgently needed in an urgent manner.
With an open head injury, primary treatment of wounds must be carried out. This should be done in a medical facility. Otherwise, unpleasant consequences cannot be avoided in case of traumatic brain injury in children.
With intracranial hematomas , craniotomy is required in order to empty and remove blood clots. Be sure to carry out MRI control.
Subsequently, if necessary, bone grafting is performed in the wound area after traumatic brain injuries in children.
Effects
Traumatic brain injury is a fairly common injury in children of various ages. Among the common causes that provoke pathology, there are road transport, domestic accidents. Symptoms may vary depending on the specific type of head injury, but they are also affected by the age of the child, the presence of concomitant complications. Traumatic brain injury can lead to death or disability, provided that there is no proper treatment and clinical recommendations for traumatic brain injury in children are ignored.
Conclusion
As you can see, TBI can cause serious consequences. Therefore, in no case should you ignore your baby’s complaints of severe pain or dizziness after another fall. It is important to follow the clinical guidelines for traumatic brain injury in children.