Pediatric Head Injury Flashcards
The overall mortality for all pediatric head injuries requiring hospitalization has been reported between 10 and 13%. Which of the following are injuries peculiar to pediatric patients?
● A. Birth injuries like skull fractures, cephalhematoma, epidural and subdural hematomas, brachial plexus injuries
● B. Perambulator/walker injuries, nonaccidental injuries (formerly called child abuse), for example, shaken baby syndrome, and injuries from skateboarding, scooters
● C. Injuries related to the easier penetrability of the pediatric skull like recreational lawn darts, cephalhematoma
● D. Leptomeningeal cyst also known as growing skull fracture or retroclival hematoma
● E. All of the above
E. All of the above
CT is recommended in a patient below 2 years of age with less than or equal to 14 or other signs of altered mental status. Which of the following is another condition in which CT of brain is a must?
● A. Occipital, parietal, or temporal scalp hematoma
● B. Palpable skull fracture
● C. History of loss of consciousness for more than or equal to 5 seconds
● D. Severe mechanism of injury
● E. Not acting normally according to the parents
B. Palpable skull fracture
A child with GCS 14 or 15 and normal CT scan can be considered for home observation if neurologically stable. What is the risk of these patients to have an occult brain injury?
● A. 0%
● B. 2%
● C. 4%
● D. 6%
● E. 8%
A. 0%
Cephalhematoma are of two types. One is subgaleal hematoma in which bleeding separates galea from periosteum while the other is subperiosteal hematoma (some refer to this as cephalhematoma) which is most commonly found in the newborn. What is the recommended treatment for these?
● A. Aspiration of the blood as soon as possible
● B. If the lesion is calcified then there is no need of surgery for cosmetic reason
● C. Treatment beyond analgesics is almost never required and almost usually resolve within 2 to 3 weeks
● D. There is no need to follow hematocrit or hematoma in large lesions
● E. Percutaneous aspiration of cystic component
C. Treatment beyond analgesics is almost never required and almost usually resolve within 2 to 3 weeks
A young child after a fall from height develops scalp mass with head pain alone. Radiography shows progressive widening of fracture and scalloping or saucering of edges. Mean age at injury is less than 1 year and over 90% occur before the age of 3 years. Post-traumatic leptomeningeal cysts rarely occur
after more than 6 months of the injury. Which of the following are surgical steps are necessary for post-traumatic leptomeningeal cysts?
● A. Wide craniotomy around the fracture
● B. Repair of the dural defect
● C. Replacement of the bone
● D. Pseudo growing fractures should be followed with X-rays
and operated only if expansion persists beyond several
months
● E. All of the above
E. All of the above
Most common skull fractures in pediatric age group is frontal and parietal regions. In young children, remodeling of the skull occurs as a result of brain growth as it tends to smooth out the deformity. What are the indications of surgery in case of simple skull fractures?
● A. Definitive evidence of dural penetration
● B. Persistent cosmetic defect in the older child after the swelling has subsided
● C. Focal neurologic deficits related to the fracture
● D. All of the above
D. All of the above
Ping pong fracture is a green stick type of fracture in which caving of focal area of bone occurs as in a crushed area of a ping pong ball. It is usually seen in only newborn due to plasticity of the skull. Which one of the following is not an indication of surgery in these patients?
● A. When fracture is in the temporoparietal region in the absence of underlying brain injury
● B. Radiographic evidence of intraparenchymal bone fragments
● C. Associated neurologic deficit and signs of increased ICP
● D. Signs of CSF leak deep to the galea
● E. Situations in which the patient is unable to come for longterm follow-up
A. When fracture is in the temporoparietal region in the absence of underlying brain injury
Dural sinus thrombosis (DST) or compression may occur if fracture of skull bone occurs in the vicinity of dural sinuses. Anticoagulation is recommended in children with DST. What are the advantages of giving anticoagulation in these patients?
● A. Reduction in the incidence of thrombus propagation
● B. Decreases venous infarction
● C. Reduces poor outcome incidence
● D. All of the above
D. All of the above
Vigorous shaking of a child produces violent whiplash like angular acceleration decelerations of the head which may lead to significant head injury. All of the following are findings in a shaken baby syndrome child except?
● A. Epidural hematoma
● B. Subdural hematoma
● C. Subarachnoid hematoma
● D. Retinal hemorrhages
● E. Marks on chest, multiple ribs fracture, or pulmonary contusion
A. Epidural hematoma
According to the PECARN algorithm for children < 2 years of age, if the patient has parietal scalp hematoma and history of LOC for > 5 seconds, what is the guideline for CT scan?
● A. Recommended
● B. CT versus observation based on physician’s experience
● C. Parental preference
● D. CT not recommended
B. CT versus observation based on physician’s experience
Subperiosteal hematoma seen in newborn babies absorbs on its own in what percentage of patients?
● A. 50%
● B. 60%
● C. 70%
● D. 80%
● E. 90%
D. 80%
What is the treatment for a true post-traumatic leptomeningeal cyst?
● A. Analgesics
● B. Observation
● C. Serial imaging
● D. Surgery
● E. No treatment indicated
D. Surgery
In temporoparietal ping pong fractures, surgery is not indicated in which of the following?
● A. Radiographic evidence of intraparenchymal bone fragments
● B. Associated neurological deficit
● C. Signs of raised ICP
● D. CSF leak deep to galea
● E. Patient can have long-term follow-up
E. Patient can have long-term follow-up
What is the investigation of choice for retroclival hematoma?
● A. Plain CT of brain
● B. Plain MRI of brain
● C. CT angiography
● D. MR angiography
● E. Duplex scan
B. Plain MRI of brain
