Pediatric TBI Flashcards
What is a Traumatic Brain Injury (TBI), and what are its characteristics?
Traumatic Brain Injury (TBI) is caused by an external mechanical force impacting the head. Characteristics include diminished or altered consciousness ranging from brief lethargy to prolonged unconsciousness or brain death.
What are the differences between open head injury and closed head injury? Provide examples.
- Open Head Injury: Penetration through the skull to the brain (e.g., gunshot wound, knife injury).
- Closed Head Injury: Brain injury without penetration (e.g., concussion, contusion, hypoxia).
What are the most common causes of TBI in different age groups?
- < 12 months: Falls
- 1-4 years: Abuse or assault.
- 4-14 years: Motor vehicle accidents (MVA).
- School-age/adolescent: Sports (29%) and gunshot wounds.
Define acceleration/deceleration injuries and explain their common forms.
Acceleration/Deceleration Injuries occur when a moving head hits a fixed object, causing coup or contrecoup contusions. Forms include translational (lateral displacement) and rotational (skull rotation while the brain remains stationary).
What is the difference between primary brain damage and secondary brain damage?
- Primary Brain Damage: Initial injury caused directly by trauma (e.g., concussion, contusion, skull fractures).
- Secondary Brain Damage: Evolves from pathophysiologic changes (e.g., cerebral edema, increased intracranial pressure).
What is diffuse axonal injury, and how does it occur?
Diffuse Axonal Injury (DAI) involves widespread damage to axons in the brain caused by shearing forces during rotational injuries.
What is the significance of cerebral edema and increased intracranial pressure (ICP) in TBI?
- Cerebral Edema: Swelling of the brain that increases pressure.
- Increased Intracranial Pressure (ICP): Elevated pressure inside the skull, potentially leading to herniation and brain damage.
What is the role of coma scales in assessing pediatric TBI?
- Coma scales, such as the Glasgow Coma Scale and Pediatric Glasgow Coma Scale, evaluate the depth of unconsciousness and predict recovery.
- Lower scores (e.g., 3-4) indicate poor prognosis, while higher scores (>7) indicate better outcomes.
What are some non-traumatic causes of brain injury in children?
Non-Traumatic Causes
- include hypoxia/anoxia (e.g., near drowning)
- cardiac arrest
- brain tumors (e.g., gliomas)
- strokes (e.g., IVH, HIE)
- infections (e.g., encephalitis, meningitis)
What are the common mechanisms of injury in pediatric TBI?
Acceleration/Deceleration, Translational, Rotational, and Impression Injuries. Each mechanism involves unique forces acting on the brain during trauma.
Define acceleration/deceleration injuries and their effects on the brain.
Acceleration/Deceleration Injuries occur when a moving head strikes a fixed object, causing brain contusions such as coup (injury under impact site) and contrecoup (opposite site). Infants are particularly susceptible.
What is a translational injury, and how does it differ from rotational injury?
- Translational Injury: Lateral displacement of the skull and brain as the head strikes a stationary object.
- Rotational Injury: Skull rotates while the brain stays stationary, leading to shearing forces.
What are rotational injuries, and why are they significant in TBI?
Rotational Injuries occur when the skull rotates but the brain remains stationary, causing shearing of axons and diffuse axonal injury (DAI), common in severe TBI.
Explain impression injuries and their potential outcomes.
Impression Injuries occur when a solid object impacts a stationary head, causing focal lesions or skull fractures. Also referred to as blunt force trauma.
How do acceleration/deceleration injuries differ in infants compared to adults?
Infants are more vulnerable due to weaker neck muscles and a softer skull, leading to more significant coup/contrecoup injuries and brain contusions.
What role do mechanisms of injury play in determining TBI severity?
Understanding the mechanism (e.g., rotational vs. impression) helps predict injury patterns (e.g., diffuse vs. focal damage), guiding assessment and treatment plans.
What is the difference between primary brain damage and secondary brain damage in TBI?
- Primary Brain Damage: Direct result of trauma at the moment of injury (e.g., concussion, contusion, skull fractures).
- Secondary Brain Damage: Evolving damage due to pathophysiological changes (e.g., cerebral edema, hypoxic-ischemic injury).
What are the types of injuries included in primary brain damage?
- Concussion: Temporary functional disruption.
- Contusion: Bruising of the brain.
- Skull Fractures: Linear or depressed fractures.
- Intracranial Hemorrhages: Extradural and intradural hematomas.
- Diffuse Axonal Injury (DAI): Widespread axonal shearing.
What complications are commonly associated with secondary brain damage?
- Cerebral Edema: Brain swelling.
- Increased Intracranial Pressure (ICP): Elevated pressure in the skull.
- Herniation Syndromes: Brain tissue displacement.
- Hypoxic-Ischemic Injury: Lack of oxygen and blood flow.
How does diffuse axonal injury (DAI) contribute to TBI severity?
Diffuse Axonal Injury (DAI) results from shearing forces during rotational injuries, leading to widespread axonal damage and severe neurological impairment.
What is the role of intracranial hemorrhages in TBI, and what types are there?
Intracranial Hemorrhages: Bleeding within the skull caused by trauma. Types include extradural hematomas (bleeding between dura and skull) and intradural hematomas (bleeding beneath the dura).
What are the potential long-term consequences of secondary brain damage in pediatric TBI?
Long-term consequences include chronic hydrocephalus, seizures, infections, dysautonomia, and endocrine disorders, significantly impacting recovery and function.
Why is it critical to manage increased intracranial pressure (ICP) in TBI patients?
Uncontrolled ICP can lead to brain herniation, reduced cerebral perfusion, and irreversible brain damage, making its management a priority in acute care.
What are the key predictors of TBI severity and recovery in children?
- Duration of Coma: Shorter duration (< 1 night) predicts better recovery; > 1 week indicates poor outcomes.
- Depth of Coma: Glasgow scores (3-4 poor, >7 good).
- Duration of Post-Traumatic Amnesia (PTA): Longer PTA suggests worse outcomes.
