MILD
FORMS OF TRAUMATIC BRAIN INJURY IN CHILDREN: DIAGNOSIS AND THERAPY
Kolomysova
Yu.S., Shevchenko P.P.
The
Stavropol State Medical University
Department
of Neurology, Neurosurgery and Medical Genetics. Stavropol, Russia
Relevance. Mild traumatic brain
injury (TBI) in children is one of the urgent problems of mankind. As TBI
causes a number of changes in the functional state of the central nervous
system, the given circumstancein turn leads to disruption of specialized brain
structures with subsequent destabilization of the forming integrated brain
functions.
Among all childhood injuries requiring hospitalization, traumatic brain
injury, played the leading part. They make up 37.6% of all child injury.
According to WHO data, marked by constant growth TBI rate of 1-2% per
year.
Even mild traumatic brain injury in childhood, affects the entire
subsequent period of a child's life. At the same time, children more often than
adults, have possible favourable outcome after severe traumatic brain injury as
a result of high compensatory brain capacity of the child.
Objective: to analyse modern
methods of diagnosis and treatment of mild forms of traumatic brain injury in
childrenaccording to scientific articles, monographs, textbooks, especially
clinical picture.
Results. In traumatic brain injury
mechanical energy affects not only the cranium, but also its contents (the
brain, meninges, cranial nerves). Features of the developing child's organism
contribute distinctiveness of traumatic lesions and clinical manifestations of
traumatic brain injury. For children, especially in the early age, skull
fractures as linear or concave type celluloid balls, generally not accompanied
by symptoms of the nervous system, which in turn hinders the timely diagnosis
of brain damage and may lead to serious consequences.
The main clinical forms of traumatic brain injury: concussion,
contusion, compression of the brain. Based on this classification, it is found
that mild head injury is observed in 60-80%, medium - 10-20%, severe - in 10%
of cases.
Concussion - a mild form of diffuse brain injury in which there are no
macrostructural change. Clinically, there is a loss of consciousness lasting
from a few seconds to a few minutes. The loss of consciousness in children can
be absent, or goes unnoticed. Typical short retro-, anterograde amnesia, which,
given in the different ages of the children, is not always a reliable
criterion. The children in first months of life may be seen with spontaneous
vomiting or regurgitation after injury.After regaining consciousness typical
complaints of headache, dizziness, weakness, tinnitus, flushing, sweating, and
sleep disorders. There may be pain when moving the eyeballs, double vision when
trying to read, vestibular hypersensitivity. Vital functions are not affected.
Mild contusion of brain is characterisedby loss of consciousness within a few
minutes to several minutes of trauma. On restoration of consciousness main
complaints are of headache, dizziness, nausea.Usually, there is retro-, con-,
anterograde amnesia. Vomiting is frequently repeated. Vital functions are not
affected. Occurrence of mild brady- or tachycardia, sometimes - hypertension.
Neurological symptoms are usually mild (nystagmus, pyramidal insufficiency,
meningeal symptoms, and others.), regressing to 2-3 weeks after the injury.
Possible fractures of the cranial vault and subarachnoid hemorrhage.CT often
reveals a low-density area of the brain matter, corresponding to swelling.
Cerebral edema may be local, lobular or hemispheric; is also seen as a
constriction of cerebrospinal fluid spaces, these changes are detected during
the first hours after the trauma, usually peaks on the third day and disappears
after 2 weeks.
Treatment.
For concussion:
I) bed rest for 1 week is necessary;
2) use of sedative, desensitizing, vegetotropic drugs.
3) dehydrating agent for cerebral concussion are assigned individually,
since it is not always accompanied by symptoms of cerebral edema and
intracranial hypertension. But after the acute period - a week is advisable to
apply neurometabolic drugs. A stay at the hospital for 7-10 days can not only
carry out a course of treatment, but also to exercise the dynamic observation
of the patient, to exclude compensated phase of traumatic compression of the
brain ("lucid interval"). This fact determines the need for
hospitalization of patients (especially children) with brain concussion. In
brain injury from mild to moderate severity is treated asconcussion of the
brain, with the addition of agents that improve cerebral blood flow
(reopolyglucine, cavinton, euphylline, teoni- col), power supply of the brain
(glucose in the form of polarizing mixture), the restoration of the blood-brain
barrier function (euphylline, papaverine), and dehydrating and
normotensive-antinflammatory ( in subarachnoid hemorrhage, wounds on the head
and CSF), metabolic therapy. During subarachnoid hemorrhage the medical complex
include hemostatic therapy (5% solution of aminocapronic acid, contrycal, trasilol,
gordocs).
Conclusions: The high prevalence and the annual increase in patients
with traumatic brain injury (TBI), various pathological intracranial processes
triggering mechanical head injury, polymorphism of neurological symptoms in
children significantly complicate diagnostic study.
Thus, TBI in children has its own clinical, organizational and
therapeutic features. However, the first priority should be regarded as the
solution of organizational problems that will improve early diagnosis. Solving
the organisational problems will allow:
• improve the efficiency of diagnosis traumatic brain injury, and
accordingly, its treatment;
• reduce mortality;
• reduce the amount of residual changes;
• reduce the indicators of disability;
• minimize economic losses.
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