Conditions with Cerebral Dysfunction in the Pediatric Patient

Head injuries involve trauma to the brain and its surrounding structures that are the result of an external force, and can include injuries like lacerations, skull fractures, and concussions.

Alright, so, lacerations are tears of the scalp typically caused by blunt trauma or penetration with a foreign object. Skull fractures are breaks in the skull bone, and include linear fractures, which cause a crack in the skull bone that does not cross suture lines; comminuted fractures, which consist of multiple linear fractures; depressed fractures, where pieces of skull bone push inward, causing hematomas, which is a pooling of blood outside a blood vessel, or lacerations of the brain tissue; and basilar fractures, which occur at the base of the skull.

Then, there are mild traumatic brain injuries, or concussions, which cause a transient disruption in normal neurologic function resulting in an alteration in mental status and sometimes a temporary loss of consciousness.

Now, head injuries can be caused by several mechanisms, like contact head injuries, acceleration-deceleration injuries, and penetrating injuries. Contact head injuries occur when a child hits their head on a hard surface, like when falling down the stairs; or when they receive a violent blow or jolt to the head, like when a child is tackled during a football game.

On the other hand, acceleration-deceleration injuries happen when the brain bounces around inside the skull, like in a car accident, or if a child is repeatedly shaken, like with shaken baby syndrome. The bouncing of the brain inside the skull causes a contusion, or bruising of the brain, at the site of impact, called coup injury.

Then, the recoil force directs the brain the other way to strike the opposite side of the skull, resulting in a contusion on the other side of the brain, called contrecoup injury. Lastly, head injuries can also be caused by penetrating injuries, like knife or gunshot wounds.

Risk factors for head injuries include playing contact sports, child abuse, and being younger than one year old. Also, children's heads often respond differently to an external force because their heads tend to be relatively heavy, they are larger compared to the rest of their body, and they have weaker musculoskeletal support for their head.

Head injuries can lead to complications like infection, bleeding, cerebrospinal fluid leaks, seizures, cerebral edema, and increased intracranial pressure, or ICP, due to the swelling of the brain tissue or when there’s bleeding inside the cranium.