Ch60 Paediatric head injury Flashcards
What are the guidelines to CT scan a child following a head injury?
CT scan for neurological or cognitive dysfunction or suspicion of a depressed / basilar skull fracture
What imaging would you perform for a child <1 year old who is not having a CT head?
Skull xrays
Define minor head injury.
GCS > 13 without neurological deficit
What proportion of children with >5min LOC have a brain injury?
22% compared to 8% if LOC <5 mins
What imaging modality should be considered instead of CT head?
MRI
What is a ping-pong fracture?
A green stick fracture of the skull with caving of the skull in a region. Mainly in newborns due to skull plasticity.
How would you manage a temporo-parietal ping-pong fracture?
Conservative if no underlying brain injury - usually corrects itself as the skull grows
When would you operate on a ping-pong fracture?
Raised ICP
CSF leak through to the subgaleal space
Neurological deficit
Cosmesis if on the forehead
What proportion of <10 year olds with a head injury are NAI?
10%
What age group is NAI highest?
<3 years old
Which assocated injuries are suggestive of NAI?
Retinal haemorrhage
Bilateral CSDH <2 years
Multiple skull fractures
Where neurological injury does not fit external trauma
What is the pathological mechanism in shaken-baby syndrome?
Angular acceleration / deceleration of the head (due to larger proportion to body and weaker neck muscles). Death is due to uncontrollable ICP
look for CCJ injury
What is Purtscher’s retinopathy?
Loss of vision following major trauma / pancreatitis / child birth etc due to posterior pole ischaemia. No known treatment
Where do NAI skull fractures occur?
90% are parietal
How can NAI fractures be differentiated from non-NAI trauma fractures?
Multiple / bilateral fractures or those that cross sutures
What is a traumatic leptomeningeal cyst?
Growing skull fracture in which a CSF leak causing the fracture edges to widen with time
What age do growing skull fractures occur?
<3 years
What are the radiological features of a growing skull fracture?
Widening sutures with scalloping of the edges
What is the management of a growing skull fracture?
Closure of the dural defect. The dural defect is usually larger than the bony defect so perform a craniotomy around the fracture, repair the dura and then replace the bone
How do you manage depressed skull fractures in children?
Conservatively unless:
1) Dural penetration
2) Persistent cosmetic defect
3) Focal neurological deficit attributable to the fracture
