Head Injuries and Brain Pathology

Question 1

Most children with head injuries are _______
those with a poor outcome _________

Answer 1

• Most children with head injuries are well enough to send home after assessment without a CT scan
• Head injuries with a poor outcome tend to be those from a dangerous mechanism e.g. RTA or fall from height (fall from height would be classed as a fall from their own height or higher, this therefore may not seem a significant height to an adult)

Question 2

Safety netting for children being sent home following a head injury?

Answer 2

children need to be brought back in if they are persistently drowsy or out of character, have a persistently bad headache or are persistently vomiting

Question 3

List some things that are indications for a head CT following a head injury?

Answer 3

• Loss of consciousness at time of injury is important fact to find out, up to a minute is okay, but over a minute is an indication for a head CT
• Vomiting more than 3 times is an indication for a CT scan
• If a child does not settle with reassurance and analgesia they need a CT scan
• Any child who is not A on AVPU needs a CT scan

Question 4

Are firm lumps following head injury worrying? What is worrying?

Answer 4

• Firm lumps are hardly ever signs of fractures, you are more worried if a lump is soft or boggy as this can suggest an underlying fracture

Question 5

Brief overview of SAH and SDH in Newborns?

Answer 5

• Both SAH and SDH can occur in newborns
• It generally occurs either from birth trauma (excessive mechanical force on the baby during birth) or hypoxic-ischaemic injury (lack of oxygenated blood flow to the brain)
• Signs: respiratory depression, apnoea, seizures, irritability, altered tone, altered level of consciousness
• CT is used for diagnosis
• Management depends on location and extent of bleed, some can be monitored and giving blood transfusions and antiepileptics if needed
• Many babies will go on to have no lasting problems, some may have complications though

Question 6

Explain what is meant by cerebral palsy and describe some causes?

Answer 6

• Umbrella term encompassing disparate disorders that are apparent at birth or in childhood and are characterised by non-progressive motor deficits
• Non progressive disease – single insult – doesn’t get worse or better over time
• A variety of intrauterine and neonatal cerebral insults may cause CP including prematurity ad its complications, hypoxia, intrauterine infections and kernicterus (high bilirubin causes brain damage)
• In many, cases no specific cause can be identified

Question 7

Clinical features of cerebral palsy?

Answer 7

• Failure to achieve normal milestones is usually the earliest feature
• Specific motor features usually become apparent later in childhood
• 70% will have spastic CP
• Co-morbidity is common – particularly epilepsy and learning disabilities

Question 8

Management of cerebral palsy?

Answer 8

• MDT approach – physiotherapy, SALT, OT
• Botox injections to relax muscles
• Baclofen or diazepam for muscle stiffness
• Melatonin for sleeping difficulties
• Analgesia for pain
• Surgery if needed

Question 9

Explain what is meant by hypoxic ischaemic encephalopathy?

Answer 9

• Hypoxic ischaemic encephalopathy is brain injury due to lack of oxygen in the infant’s brain
• It can cause cerebral palsy or it can cause cognitive impairments, vision, hearing and motor issues
• Cerebral palsy is characterised by lack of motor function and often arises in children whose HIE has affected areas in brain responsible for motor control

Question 10

What is caput succedaneum?

Answer 10

puffy swelling that usually occurs over the presenting part and crosses suture lines