CHILDHOOD HEAD TRAUMA
Childhood head injuries do not differ from adults in many respects.
The physician who encounters a child who has had a head injury should not be influenced by the two opposing views that come up from time to time, that children are small adults or, on the contrary, completely different creatures, and should find a common way.
In newborns, the head is larger than the body. Therefore, not only polytraumas but also small blood losses such as epidurals can cause shock.
Distortion, venous epidural hematoma, enlarging fractures, ping-pong fractures, intracranial hyperemia, ischemia and swelling in the medulla spinalis and medulla oblongata, extra and intracranial hemorrhages due to vacuum delivery are common in this age group.
In infants, the head is larger than the body and the risk of easy shock continues.
It is known that providing normal haemostasis during the transfer from the moment of trauma to the center, especially in severe head trauma, prevents secondary damage.
It is also important that the first responder performs a modified GCS assessment.
External lesions are determined by palpating the scalp in FM. It should be kept in mind that even subgaleal hematomas can cause serious blood loss in young children.
It is difficult to assess GCS in children younger than 7-8 years, and therefore some modified systems have been developed.
Hospitalization criteria
Significant loss of consciousness, pedestal fractures
Severe and persistent headache
Persistent vomiting or seizure
Suspicion of child abuse
prolonged posttraumatic amnesia
Abnormal CT findings
penetrating injury
Rhinorrhea or otorrhea
Lack of IT provision
Difficulty returning the patient from home or lack of adequate care and supervision at home
skull fractures
Skull fractures are more common, especially in young children, probably due to insufficient ossification.
The most useful method for diagnosis is direct radiographs. However, although CT can miss linear fractures (especially parallel to axial sections) from time to time, it gives sufficient information about brain parchymal damage.
Linear fractures
It forms 2/3 of the fractures.
It usually heals spontaneously within 1 month and does not require any special treatment. However, it should be known that there is a serious trauma and even in children with normal neurological examination, the detection of a fracture increases the probability of intracranial hemorrhage a hundredfold.
Subgaleal or subperiosteal (cephalic) hematoma can be seen in 70%.
Compression fractures
It constitutes 25% of fractures and is usually caused by falls or focal blows, so loss of consciousness is not uncommon.
On the other hand, fractures with normal parenchyma, called ping-pong, are common in YD, mostly due to falls.
Although compression fractures have been claimed to cause late epilepsy, they are now accepted as the result of existing brain damage.
Surgical indications
1-A tabula or deeper than 1 cm
2- Causing serious brain pressure
3-Creating an aesthetic defect
4-CSF and parenchyma fistula