home Auditorium 7 Post-traumatic blindness in a child. Post-traumatic retinopathy of the eye. Possible development of post-traumatic blindness in some cases

Post-traumatic blindness in a child. Post-traumatic retinopathy of the eye. Possible development of post-traumatic blindness in some cases

Excessive activity and mobility, lack of fear and sense of self-preservation often lead to injury and become the reason why a concussion can occur in children, regardless of age. Sometimes, to keep track of a baby who is trying to learn the world, even the most vigilant and attentive parents fail. Often a concussion occurs in a schoolchild who has no idea about the consequences and complications of craniocerebral disorders. In this case, it will not be possible to get by with a simple bruise, lump or hematoma, and treatment will require mandatory hospitalization.

Severity of concussion

But it's not that dangerous external manifestation skin damage, how many closed craniocerebral trauma or concussion in children with subsequent disruption of the central nervous system nervous system and organ at the internal cellular level. Even a severe head injury requires immediate examination by a doctor to rule out intracranial changes.

A child who has received a mild concussion of the first degree experiences weakness, slight dizziness, and possible vomiting. Consciousness is present. After 20-30 minutes, children return to normal activities and games.

II degree or concussion in children moderate severity. At this stage, there are minor damage to the structure of the skull, hematomas and soft tissue bruises. The victim may lose consciousness in the first minutes, be disoriented in space, and feel nausea and bouts of repeated vomiting for several more hours.

Severe or III degree. Accompanied by injuries, fractures, severe bruises, hemorrhages, prolonged and frequent loss consciousness. Hospitalization, rest, round-the-clock observation by doctors and intensive treatment more than 2 weeks.

Over 1,230 young patients in Russia are diagnosed annually in neurosurgical departments with serious head injuries. If we rely on statistical data, the braincase and skull are most often affected in children under one year and 4-6 years old - more than 21%; among schoolchildren, these data exceed 45% of the total number of all cases. In infants and newborns, rates reach 2%, and in toddlers — 8%.

Concussion is one of the most common diagnoses in pediatric traumatology. This is due to the high physical activity children, which is combined with a reduced sense of danger and imperfect coordination of their movements. Thus, about 90% of cases of traumatic brain injury are caused by concussion, which can be quite severe consequences. Let's look at the symptoms of a concussion in a child, its consequences and the main diagnostic methods.

Causes

A concussion is a spontaneous disruption of brain function that usually occurs immediately after a head injury. The symptoms of a concussion in a child differ significantly from the manifestations of this condition in adults. These differences are especially typical for young children.

Concussions in infants are caused by careless parents, which can result in children falling from a crib, changing table, stroller, or even from their parents' arms. Typically, concussions in children in the first year of life are asymptomatic or symptoms are very mild. The baby may experience bad dream at constant drowsiness, lack of appetite, crying for no reason, pale skin, regurgitation during feeding, nausea, vomiting. However, loss of consciousness usually does not occur.

After a child begins to walk, the main cause of a concussion is a fall from his own height, slides, stairs, windows, roofs, trees. At the age of one to 4-5 years, this condition can occur due to the “shaken baby” syndrome, that is, after the body is exposed to sudden braking or acceleration.

Symptoms

Symptoms of a concussion include loss of consciousness, nausea and vomiting after injury. The child also experiences headaches, sweating, pale skin, and jumps. blood pressure and pulse, often – sleep disturbance, moodiness and tearfulness. Symptoms of a concussion include post-traumatic blindness, which occurs in some cases. It may appear immediately after the injury or a little later, and disappears on its own after a few minutes or hours.

Another feature of the manifestation of a concussion is that the symptoms of this pathology appear some time after the fall and begin to rapidly increase.

Consequences of a concussion

Despite the fact that a concussion does not lead to structural changes in the brain, the consequences can be very serious.

First of all, it should be noted that this pathology leaves a memory of itself for life and manifests itself in the form of excessive vulnerability and irritability of a person. He will get tired more often than others, cry, fall into depression. It is difficult for him to tolerate cold and heat, and may often appear insomnia.

Most frequent consequences concussions happen emotional outbursts, often quite aggressive, prone to convulsive conditions, increased susceptibility to viral and infectious diseases. In addition, the baby may suffer from headaches, it will be difficult for him to concentrate, which, of course, will affect his school performance.

The consequences of a concussion in a child include neuroses, which are manifested by vasomotor instability, migraine, insomnia, feelings of fear and anxiety, and nervousness. Sometimes it is possible to develop psychoses, in which hallucinations, delusions and disturbances of perception appear.

A severe complication of a concussion is postconcussion syndrome, in the case of which, some time after the injury, the child develops constant dizziness, high-intensity headaches, insomnia, irritability, severe anxiety. This condition requires immediate treatment, although it is very difficult to get rid of it even with the help of therapy.

How to identify a concussion in a child

If your baby has suffered a traumatic brain injury, you must call ambulance who will take him to the hospital for consultation with a neurologist or neurosurgeon. If necessary, the doctor will conduct examinations of the patient.

Diagnosis begins with an examination by a specialist. Further, if necessary, additional examinations are prescribed.

For children of the first or second year of life, preference is given to such an examination method as neurosonography - ultrasonography brain tissue.
Older children usually undergo X-rays and echo-encephalography (ultrasound method). The most accurate hardware methods for examining the state of the brain are computed tomography (CT) and magnetic resonance imaging (MRI).
For special indications, electroencephalography can be used, which makes it possible to determine the bioelectrical activity of brain structures. It is carried out to assess the severity of the injury and identify possible foci of epileptic activity. In particularly severe cases, the doctor may prescribe a lumbar puncture for the child.

First aid for a child after an injury is to ensure complete rest and treat the wound, if any. Young children are subject to mandatory hospitalization. After being examined by a doctor and establishing their satisfactory condition, older children are prescribed rest at home. Usually, 2-3 weeks after receiving a concussion, their condition returns to normal. If there is any deterioration, the child must be immediately shown to a doctor.

According to epidemiological studies, every year in many countries the number of new cases of traumatic brain injury (TBI) among children and adolescents reaches 180-200 per 100 thousand people. The most common is mild TBI (including concussion and contusion). mild degree), which accounts for approximately 80% of all cases. Moderate and severe TBI account for about 15% of cases, the remaining 5% are extremely severe TBI, often ending fatal. TBI is the leading cause of disability and mortality among children and adolescents.

Two main age groups at increased risk of TBI: under 5 years old, 15-25 years old. At the same time, the absolute maximum cases of TBI occur in the second age group and are often associated with alcohol consumption and road traffic accidents. Among victims with TBI, about 70% are male patients.

The classification of TBI is based on the nature and extent of brain damage. Closed TBI includes injuries in which there is no violation of the integrity of the scalp or there are soft tissue wounds without damage to the aponeurosis; open TBI includes fractures of the bones of the cranial vault, accompanied by damage to the aponeurosis, fractures of the base of the skull, bleeding or liquorrhea (from the nose or ear).

Brain damage due to TBI is divided into primary (focal and diffuse) and secondary. Primary injuries include those that occur when exposed to mechanical energy (bruises, crushes of brain tissue, diffuse axonal damage, primary intracranial hematomas, brain stem contusions, etc.). Secondary damage occurs as a result of the adverse effects on the brain of a number of additional intra- and extracranial factors, which provoke a chain of complex reactive processes that aggravate the severity of the primary damage.

Basic clinical forms TBI can be represented by focal and diffuse lesions.

Focal damage:

brain contusion;
compression of the brain - intracranial hematoma (epidural, subdural);
intracerebral hemorrhage;
subarachnoid hemorrhage.

Diffuse damage:

brain concussion;
diffuse axonal damage;
diffuse vascular damage(including hypoxic-ischemic).
The clinical course of TBI is usually divided into the following periods:
acute: first 2-10 weeks after injury;
intermediate: from 10 weeks to 6 months;
long-term: from 6 months to 2 or more years.

When assessing the severity of TBI and predicting its course, the following indicators are taken into account:

duration of loss of consciousness in acute period injuries;
Glasgow Coma Scale (GCS) score;
duration of post-traumatic amnesia;
vital status assessment important functions, focal symptoms in the area of primary lesion and dislocation - according to the scale of the Research Institute of Neurosurgery named after N. N. Burdenko A. N. Konovalov, L. B. Likhterman, A. A. Potapov et al., 1998).

Depending on the severity of TBI, the following duration of loss of consciousness may be noted in the acute period of injury (R. Appleton, T. Baldwin, 1998):

mild - duration of loss of consciousness less than 20 minutes;
moderate - from 20 minutes to 6 hours;
severe - from 6 to 48 hours;
extremely severe - more than 48 hours.

Meanwhile, in children, especially younger age groups, loss of consciousness with TBI is not always observed and may even be absent in severe trauma.

To assess the condition of patients with closed TBI, GCS is widely used (B. Jennett, G. Teasdale, 1981), which allows one to judge not only the severity, but also make a prognosis for TBI. Overall rating according to the GCS is calculated by adding the scores for each of three groups of reactions: eye opening, vocalization (or speech activity), motor activity. To increase the sensitivity and prognostic significance of the traditional scale in pediatric practice, age-specific modifications of the GCS have been proposed for children under 1 year of age and for children from 1 to 5 years of age; for children 6-15 years old, the same version of the scale is used as for adult patients (A. S. Iova et al., 1999). The overall GCS score can vary from 15 to 3 points. The severity of TBI according to the GCS is determined as follows (B. Jennett, G. Teasdale, 1981; K. M. Yorkston, 1997):

easy: initial score 13-15 points;
moderate: (1) initial score - 9-12 points or (2) initial score - 13-15 points, but after 3 days the score does not reach 15 points;
severe: initial score - 3-8 points.

Since its development in 1974, the GCS has been widely used to determine the severity of TBI. It has been proven that as the total GCS score decreases, the likelihood of adverse outcomes increases. When analyzing the prognostic significance of the age factor, it was found that it significantly affects both mortality and disability in TBI. Despite some inconsistencies in the literature, outcomes are found to be better in children than in adults.

Originality clinical course and outcomes of TBI in children is due to the fact that mechanical energy affects the brain, the growth and development of which is not yet complete. Due to the high plasticity of the developing brain, children are more likely to have a favorable outcome than adults, including after severe clinical variants of TBI. Meanwhile, even mild TBI in childhood does not always go away without leaving a trace. Thus, it is shown that in long term after a concussion (in the range from 6 months to 3 years) in at least 30% of patients childhood a complex of disorders is formed, referred to as post-concussion syndrome.

The main manifestations of post-concussion syndrome:

cerebrasthenic symptoms - fatigue, emotional lability, anxiety, irritability, difficulty falling asleep;
headaches, dizziness, periodically accompanied by nausea;
moderately severe disturbances in coordination of movements when examining the neurological status;
cognitive impairment (attention, memory), accompanied by difficulties associated with learning at school.

There is no doubt that moderate and severe TBIs lead to more serious consequences. It is necessary to keep in mind that the consequences of TBI may not appear immediately, but may be delayed. If TBI affects the normal course of brain development, then as a result it affects the formation of the child’s personality, his cognitive and emotional development, school learning, and the formation of social skills. The severity of psychoneurological disorders in the long-term period of TBI is largely determined by the initial severity of the injury.

Clinical manifestations of the consequences of TBI

Previously, it was believed that restoration of impaired functions after a TBI in children and adolescents occurs more fully than in adults. It was also believed that the younger the age at which the TBI occurred, the greater the likelihood of complete regression of neurological disorders. However, the results of targeted studies have not been as encouraging (J. R. Christensen, 1996). Survival after severe TBI among pediatric patients is indeed higher than among adults, but there is a possibility of delayed clinical symptoms. Indeed, it gradually became obvious that in the long-term period of moderate and severe TBI, many children retained residual neurological disorders.

Moderate TBI is usually accompanied by transient neurological disorders, only in some cases they turn out to be persistent (J. R. Christensen, 1996). The outcomes of severe TBI, according to the literature, vary quite widely.

J. D. Brink. (1980) and co-authors studied the consequences of severe and extremely severe TBI in 345 children and adolescents under the age of 18 years. The duration of coma in the acute period of TBI was more than 24 hours with a median of 5-6 weeks. In the long-term period of TBI, 73% of patients moved independently and completely took care of themselves, 10% had restrictions in movement and remained partially dependent on care, 9% recovered consciousness, but remained completely dependent on others. The work of J. F. Kraus et al (1987) showed that with a GCS score of 3-4 points in the acute period of TBI, 100% of children develop at least moderate disability, with scores in the range of 5-8 points - in 65% of those examined.

Movement disorders

Paresis or plegia of the limbs in the long-term period of TBI in children is quite rare. Often, when muscle strength is preserved, examination reveals a decrease in the speed of movement (D. Chaplin et al., 1993). Impaired motor coordination, on the contrary, is observed in many children who have suffered a TBI (J. R. Christensen, 1996).

Although the restoration of motor functions in the long-term period of closed TBI in children is in many cases satisfactory, during a neurological examination even minor motor impairments are considered pathological. Residual movement disorders affect not only the general motor activity and success in physical education and sports, but also on the attitude of peers towards the child. At negative attitude from peers, a child who has suffered a TBI develops social adaptation disorders.

Cognitive impairment

The severity of cognitive impairment in the long-term period of TBI is also determined by the initial degree of its severity. A number of disorders of higher mental functions are caused by the specific localization of lesions, in particular the predominant lesion in brain contusions of the frontal and temporal lobes. Cognitive impairment in patients with TBI often affects the following areas: mental activity, such as memory, attention, speed of processing incoming information, as well as provided by the prefrontal regions cerebral hemispheres brain executive functions (planning, organizing, decision making). However, in many cases, residual disorders are formed due to diffuse involvement of the cortex and damage to the axial structures of the brain, which modulate the functional activity of the cortex. It is the combined damage to local zones of the cerebral cortex, axial and subcortical formations that leads to the development of disorders of memory, attention, regulation of the level of mental activity, emotions and motivation.

Speech disorders

Immediately after closed TBI, children often experience speech and motor impairments, which largely regress over time. Dysarthria (bulbar or pseudobulbar) is quite common; in some cases, motor aphasia is observed, as well as respiratory control disorders, accompanied by transient stuttering, whispered or monotonous speech. Among the features of speech in the long-term period of TBI, its slow pace, difficulties in selecting words, poverty of the active vocabulary with additions may be noted. own speech facial expressions and gestures, in some cases - difficulties associated with understanding long and complex statements.

Difficulties in school

Traumatic damage to certain cortical centers can lead to specific difficulties associated with the formation of reading (dyslexia), writing (dysgraphia) or counting skills (dyscalculia), but such cases are not so common. In most children, the school skills acquired before TBI are retained or acquired again. However, in many cases it is possible to form school maladjustment caused by cognitive and speech impairments, as well as emotional and behavioral difficulties resulting from TBI. Many children and adolescents in the long-term period of TBI experience the following difficulties associated with learning at school:

The acquired knowledge is heterogeneous and fragmentary.
During lessons at school, the child has difficulty getting involved in completing assignments and copes poorly with them.
There are disturbances of attention during classes, difficulties associated with memorization are noted.
The child is sloppy, does not finish what he starts, and is not organized.
The child cannot effectively use the help of others in order to complete a task or work.
The child experiences difficulties when we're talking about about the application of information and skills, as well as in formulating conclusions and generalizations.

Emotional and behavioral disorders in children and adolescents in the late period of TBI are difficult to distinguish, since they are closely related to each other. Traumatic cerebrovascular disease is characterized by a predominance in the clinical picture of severe fatigue and irritability, sometimes reaching affective explosiveness; Against this background, hysterical, neurasthenic, hypochondriacal or depressive symptoms. Motor disinhibition, impulsiveness, inability to adhere to instructions and cope with certain tasks, and refusal to complete them are often noted. When a child or teenager finds themselves in difficult life circumstances residual effects after traumatic brain injuries serve as a predisposing factor to the occurrence of psychogenic or neurotic disorders, are a favorable basis for the pathological formation of personality. Emotional and behavioral disturbances in the long-term period of TBI make social adaptation difficult.

Behavioral disorders in the long-term period of TBI:

outbursts of irritation, episodes of aggressive behavior;
impulsiveness; motor disinhibition may be observed;
emotional lability, mood swings;
loss of motivation, interest in achieving good results when performing certain tasks and affairs;
isolation, indecisiveness, unsociability;
dependence on others: the child cannot stand up for himself;
inability to fully evaluate the results of one’s actions and correct one’s behavior;
insufficient self-control and incorrect self-esteem, which entails difficulties when communicating with others.

Post-traumatic epilepsy is one of the most serious consequences TBI suffered in childhood and adolescence. Post-traumatic epilepsy develops after open TBI - 50% of cases. Among them, in 2/3 of patients the onset of epilepsy is observed within the first year after TBI, in 90% - within 5 years after injury (including the first year of life), in another 7% of patients epilepsy develops 10-15 years after TBI. The maximum risk of developing post-traumatic epilepsy was observed in patients with focal neurological symptoms and massive damage to the central nervous system as a result of severe TBI.

In 70-80% of cases, the first epileptic seizures are accompanied by generalized convulsions (G. M. Fenichel, 1997).

After closed TBI, post-traumatic epilepsy is less common (G. M. Fenichel, 1997). Within 5 years, epilepsy develops in 11.5% of patients after severe TBI (brain contusion, intracranial hemorrhage) and in 1.6% after moderate TBI.

According to the results of a survey (N.N. Zavadenko, A.I. Kemalov, 2003) of 283 children and adolescents aged 6 to 14 years, in the long-term period of closed TBI (moderate and severe), the development of epilepsy was noted in 18 people. Among them: in 16 children, the occurrence of seizures (of the secondary generalized type) was noted in a period of 4 to 12 months after suffering a closed head injury; in two cases at the same time, closed TBI provoked the debut of idiopathic (hereditarily determined) forms of epilepsy - childhood absence epilepsy (in a 7-year-old boy) and idiopathic epilepsy with isolated generalized convulsive attacks(boy 10 years old).

Thus, post-traumatic epilepsy refers to symptomatic forms of epilepsy. It is characterized by the same features as the group of symptomatic epilepsies as a whole (A. S. Petrukhin, K. Yu. Mukhin, 2000), namely:

wide age range of onset of the disease;
presence of changes in neurological status;
frequent decline in cognitive function;
identification of regional patterns on EEG;
structural changes in the brain during neuroimaging;
frequent resistance to antiepileptic therapy, which necessitates the use of valproic acid derivatives in the treatment of many patients.

Treatment of psychoneurological disorders in the long-term period of TBI in children and adolescents

Therapeutic and rehabilitation measures in the long-term period of TBI in children and adolescents should be intensively carried out both in the first 12 months after TBI, when it is reasonable to expect the most significant results from their use, and in the future, taking into account the ongoing processes of morphofunctional maturation of the central nervous system and the high plasticity of the developing brain. These activities should be comprehensive and include methods of psychological and pedagogical, speech therapy correction, psychotherapy, physical therapy, as well as drug treatment. To overcome cognitive and speech disorders, nootropic drugs are used. Indicated for post-traumatic epilepsy long-term use anticonvulsants. In order to prevent headaches, depending on the leading mechanisms of their pathogenesis, courses of vascular, dehydration drugs or anticonvulsants are recommended. For affective disorders and behavioral disorders, antidepressants and antipsychotics are prescribed, but anticonvulsants, especially valproates (drugs of valproic acid and sodium valproate), also have high therapeutic effectiveness in these conditions. In particular, valproates reduce aggressiveness and irritability, have a normothimic effect, and smooth out the severity of affective fluctuations.

The positive effect of nootropic drugs in the long-term period of TBI in children and adolescents is manifested in improvement general well-being, regression of headaches, cerebrasthenic manifestations. In the neurological status, there is a decrease in severity motor disorders, especially in the coordination area, during a psychological examination - improvement in memory, attention, and other higher mental functions. The duration of nootropic treatment courses in patients of this group should be at least 3-4 weeks. These drugs are prescribed in the first half of the day, which is associated with their psychostimulating effect. In the first days of use, a gradual increase in dose is recommended. In the presence of liquorodynamic disorders, nootropic therapy is supplemented with the prescription of dehydration agents. In patients with post-traumatic epilepsy, before using nootropics, it is necessary to achieve complete control of seizures for 4-6 months (at least) while taking anticonvulsants continuously.

In the treatment of post-traumatic epilepsy, valproates (Convulex, Depakine, Convulsofin) are among the basic antiepileptic drugs. Their long-term purpose in stable therapeutic doses is aimed at preventing neuronal damage associated with repeated epileptic seizures. The development of neuronal damage will be indicated by: repeated epileptic seizures, decreased cognitive functions, behavioral disorders in the patient, the presence of abnormalities on the electroencephalogram and structural changes with neuroimaging. Therefore, an important direction in the treatment of psychoneurological disorders in the long-term period of TBI is neuroprotection, which implies anti-epileptic therapy in combination with functional and metabolic protection of the brain. The neuroprotective properties of valproate are confirmed the following features actions:

wide spectrum of antiepileptic activity (compared to other anticonvulsants);
maintaining effectiveness during therapy with maintenance doses (often relatively low);
the use of valproate does not lead to an increase in attacks;
the use of valproate does not provoke new clinical manifestations seizures;
absence of specific cognitive impairments during therapy;
absence side effects in the emotional sphere;
normalization electrical activity brain;
improving the quality of life of patients.

Approximate daily doses for valproate therapy are 15-45 mg/kg. Special forms, convenient for use in the treatment of children and adolescents, developed for the drug Convulex (). Yes, children younger age Drops for oral administration (containing 10 mg of sodium valproate per drop) or syrup (containing 50 mg of sodium valproate per ml) are prescribed.

Reducing the number of drug doses to 1-2 times a day can be achieved by using extended-release tablets containing 300 and 500 mg of sodium valproate.

Timely contacting a neurologist and carrying out rational drug therapy make it possible to achieve a significant improvement in the condition of children and adolescents in the long-term period of TBI. However, one drug therapy to overcome the consequences of TBI may not be enough. All children who have suffered a TBI need to be examined by a psychologist to identify possible violations higher mental functions. Often these violations are not severe, but even in these cases they can have an impact Negative influence on the success of school and the child’s behavior. Therefore, assistance to children who have suffered a TBI should always be comprehensive.

Literature

Zavadenko N. N., Kemalov A. I. Peptidergic nootropic drugs in the treatment of the consequences of closed traumatic brain injury in children // Bulletin of practical neurology. - 2003. - No. 7. - P. 44 - 50.
Iova A. S., Garmashov Yu. A., Shchugareva L. M., Pautnitskaya T. S. Features of neuromonitoring in comatose states in children (Glasgow coma scale - St. Petersburg and its age characteristics). Radiation diagnostics at the turn of the century. - St. Petersburg, 1999. - pp. 45-48.
Konovalov A. N., Likhterman L. B., Potapov A. A. et al. Clinical guidelines for traumatic brain injury. - M., 1998. - T. 1. - 549 p.
Petrukhin A. S., Mukhin K. Yu. Epileptology of childhood. - M., 2003. - 624 p.
Appleton R., Baldwin T. Management of brain-injured children. New York, Oxford University Press. 1998: 257.
Brink J. D., Imbus C., Woo-Sam J. Physical recovery after severe closed head trauma in children and adolescents // J. Pediatrics. 1980; 97: 721-727.
Chaplin D., Deitz J., Jaffe K. M. Motor performance in children after traumatic brain injury. Archives of Physical Medicine and Rehabilitation. 1993; 74:161 - 164.
Christensen J.R. Pediatric Traumatic Brain Injury. In: Developmental Disabilities in Infancy and Childhood. 2nd ed. Eds. A. J. Capute, P. J. Accardo, Baltimore. 1996: 245 - 260.
Fenichel G.M. Clinical Pediatric Neurology. A signs and symptoms approach. 3rd ed. Philadelphia, B. Saunders Company. 1997: 407.
Jennett B., Teasdale G. Management of head injuries. Philadelphia, F. A. Davis Co. 1981: 258 - 263.
Kraus J. F., Fide D., Conroy C. Pediatric brain injuries: the nature, clinical course and early outcomes in a defined United States" population. Pediatrics. 1987; 79: 501 - 507.

N. N. Zavadenko, doctor medical sciences, Professor
A. I. Kemalov, L. S. Guzilova
V. E. Popov, Candidate of Medical Sciences
M. I. Livshits, Candidate of Medical Sciences
E. V. Andreeva, Candidate of Medical Sciences

RGMU, Moscow
Morozovskaya children's clinical Hospital, Moscow

Traumatic brain injuries are in first place among the reasons why children are admitted to hospital trauma departments. In terms of frequency of calls, they are even ahead of fractures of arms and legs. This is due to the fact that in young children the center of gravity is disturbed due to the large weight of the head.

In traumatology, it is customary to distinguish 3 degrees of traumatic brain injury (TBI), depending on severity. A concussion belongs to the 1st (mild) degree of TBI. 2nd (moderate) degree of severity – brain contusion. 3rd (severe) degree is characterized by brain contusions, with the formation of hematomas, compression of the brain and skull fractures.

The most common cause of TBI in infancy is parental negligence. Babies fall from changing tables, cribs, fall out of strollers, or hit their heads during active games(throwing, flying, etc.).

When the baby begins to walk, the dangers become much greater. A child may fall from stairs, slides, or balconies. Sometimes, to get a TBI, a child only needs to fall from his own height. Older children get injured while mastering different kinds sports (bicycle, roller skates, skates, skis). The more restless and restless the child, the more closely he needs to be monitored.

Sometimes it is very difficult for parents to understand that their baby has a TBI, especially if the newborn has been injured. At all clinical picture In young children, when they receive a TBI, it is very different from in adults. Infants who receive a TBI usually experience nausea, vomiting, and excessive regurgitation during feeding. The skin turns pale, perspiration appears, the baby becomes capricious and refuses to eat.

In older children, fainting may be added to all of the above. If the baby is already able to express his thoughts, he may complain about headache. Important symptom TBI – post-traumatic blindness. Such blindness occurs immediately after the injury, or after 1-2 hours and goes away on its own during the day. It is difficult to assume TBI in cases where the so-called “ lucid interval" This refers to cases when the child initially feels well, and then the condition sharply worsens. Therefore, if you have even slight concerns that your baby might have suffered a TBI, immediately take him to the hospital.

In the hospital, the baby will be examined by a traumatologist, and if such a specialist is available, a neurosurgeon. If a TBI is suspected, various diagnostic measures. The simplest and most common is x-ray cranium, it allows you to find out whether the bones of the skull are broken, but does not provide information about the state of the brain. Other procedures are prescribed to study the brain: electroencephalography, neurosonography, magnetic resonance imaging, computed tomography, lumbar puncture.

The main principle in the treatment of TBI is physical and psychological rest. Therefore, it is better for the baby to go to a hospital, where his condition will be monitored by experienced medical workers. The child will be prescribed diuretics to prevent or relieve swelling of the brain, and sedatives to ensure peace. For headaches, the baby will be given painkillers, and for frequent vomiting– antiemetics. Later, the baby will be prescribed vitamins and medications that provide extra food brain With good and timely treatment The child recovers quite quickly from a TBI.

Concussion is one of the most common injuries in adults and children. Due to a fall or blow, minor damage to the skull or soft tissues of the brain occurs, resulting in impaired function of the nerve tissues. But this process usually does not lead to irreversible consequences. It is difficult to say how the disease progresses in stages. Many doctors are confident that when a concussion occurs, dysfunction of the cells of the nervous system occurs. Possible tissue displacement, disruption of connections between brain centers, malnutrition nerve cells. A concussion can cause minor complications that may be difficult to detect with MRI. Sometimes, with a concussion, a person loses consciousness, but this may not always be noticeable. Loss of consciousness can last from a few seconds to several minutes.

Causes

A child can get a brain injury anywhere: on the street, at home, in child care institutions or in transport.

Due to the carelessness of their parents, babies can fall from the changing table, bed, or stroller.
Older children learn to move, so falls are common for them.
Preschoolers and younger schoolchildren love to climb trees, stairs and slides on playgrounds. Therefore, traumatic brain injuries are also possible.
A baby's brain can be damaged by severe motion sickness.

Symptoms

Determine whether a concussion is present infants not difficult: possible regurgitation after eating, pale skin covering, nausea and vomiting, as well as capricious and restless behavior of a child with severe attacks crying.
In older children there is strong pain in the head and dizziness, pulse changes.
The child cannot concentrate his gaze and gets lost in space.
Immediately after a fall or blow, a child may lose consciousness. But loss of consciousness is more often observed in children older than one year. How to recognize another one of the symptoms of concussion in children is post-traumatic blindness. It can last from several minutes to several hours, after which it disappears without consequences.
Some signs of brain injury do not appear until several hours after a fall or blow.
With a concussion, children may experience a sharp deterioration in their health, nausea and vomiting, and a rise in temperature.
Parents need to know that concussion symptoms do not always appear immediately after the injury. Therefore, it is necessary to take the child to a doctor for examination as soon as possible.

Diagnosis of a concussion in a child

How to understand that this is a concussion - in children this is done in this way: to make a diagnosis, it is necessary to examine the child by a doctor, as well as to take a medical history. A traumatologist and neurologist will examine the baby. Accurate diagnosis will be determined after applying one of the examination methods. There are several ways to assess the likelihood of brain damage, but usually the doctor will choose one of the methods. For these purposes, computed tomography or MRI is used, and in children under 1.5 years old, ultrasound is performed. CT scan allows you to quickly and easily assess the state of the brain after a fall or blow. MRI can also help detect concussions, but the examination process is longer. And the disadvantages of MRI as a method for studying the child’s brain include administering anesthesia to the baby. For babies whose fontanel has not completely healed, an ultrasound is performed.

This will help you learn more about concussions in children and provide first aid.

Complications

Usually a concussion goes away without consequences. At timely diagnosis and treatment, the child will recover quickly. Complications usually arise in cases of improper or untimely treatment.

A mild concussion may later manifest itself in the form of headaches.
A more severe form of concussion may cause severe complications, which can cause epilepsy.
Headaches can occur due to changing weather conditions.
Insomnia, irritability, sudden mood swings - all these consequences sometimes appear due to a concussion in a child.
A “replay effect” may occur. This means that the baby will experience the same symptoms as during the injury.

If complications arise and sharp deterioration the child’s well-being, you should immediately consult a doctor and under no circumstances self-medicate.

Treatment

What can you do

If a child has suffered a traumatic brain injury, it is necessary to provide first aid and send the child for examination to a doctor. The earlier the diagnosis is made, the greater the chances of avoiding consequences and complications.
Before the doctors arrive, it is necessary to place the child in a comfortable position, but do not allow him to sleep.
At open wound on the head, it should be disinfected.
If the baby loses consciousness, he must be turned on his side.
If a child is suspected of having a concussion, painkillers should not be given and the child’s activity should not be limited.
If a child feels well after a fall or blow, but after a few hours his condition sharply worsens, an ambulance should be called immediately.

What does a doctor do

Mild concussions are usually treated at home. In the hospital, children with traumatic brain injuries are left in severe cases or if complications are suspected. Monitoring by doctors is necessary to prevent epileptic attacks, the development of hematomas and cerebral edema in a timely manner. For this reason, the child may be in the hospital for a week. If, after a computed tomography or magnetic resonance imaging scan, no abnormalities or abnormalities were found, the child remains in the hospital for about 3 days. Treatment of a concussion in a child consists of limiting physical activity, prescribing diuretics and medications with an increased amount of potassium. In some cases, the baby may be prescribed sedatives, as well as anti-allergy medications. After treatment, the child needs vitamin complexes, and he also needs to undergo regular examinations to prevent pathologies.

Prevention

It is not always possible to prevent concussions in children. Babies should be closely monitored and should not be left alone in the room, on the bed or on the changing table. It becomes more difficult to keep an eye on older children. Therefore, it is necessary to explain the rules to children safe behavior not only at home, but also on the street, in kindergartens and schools. And remember, any concussion in children requires seeing a doctor - after all slight concussion can not be!