Abstract
Head injury, either alone or in combination with multiple injuries, is common in children. Its pattern is different in children compared to adults, with diffuse cerebral swelling rather than localized hematoma being most common. The pathophysiology of pediatric head trauma is not yet clearly elucidated, but may be closely related to changes in the regulation of cerebral blood flow. The initial management and subsequent care of the child with severe brain injury are discussed from a multisystem viewpoint. The prognosis for children with severe head injury seems brighter than for adults, but there are not yet enough data to allow prediction of outcome in any individual case. Efforts to prevent, rather than treat, head injury in childhood are more likely to be beneficial.
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Aidinis SJ, Lafferty J, Shapiro HM (1976) Intracranial responses to PEEP. Anesthesiology 45:275
Alexander MP (1984) Neurobehavioral consequences of closed head injury. Neurology and Neurosurgery Update Series 5:20, Continuing Professional Education Center, Princeton, NJ
Ammirati M, Tomita T (1984) Posterior fossa epidural bematoma during childhood. Neurosurgery 14:541
Biggar WD, Bohn D, Kent G (1983) Neutrophil circulation and release from bone marrow during hypothermia. Infect-Immun 40:708
Braakman R, Schouten HJA, Dishoeck MB, Minderhoud JM (1983) Megadose steroids in severe head injury. J Neurosurg 58:326
Braughler JM, Hall ED (1985) Current application of “highdose” steroid therapy for CNS injury. J Neurosurg 62:806
Brink JD, Imbus C, Woo-Sam J (1980) Physical recovery after severe closed head trauma in children and adolescents. J Pediatr 97:721
Brown FD, Johns L, Jafar JJ, Crockard HA, Mullan S (1979) Detailed monitoring of the effects of mannitol following experimental head injury. J Neurosurgery 50:423
Brown MM, Wade JPH, Marshall J (1985) Fundamental importance of arterial oxygen content in the regulation of cerebral blood flow in man. Brain 108:81
Bruce DA, Alavi A, Bilaniuk L, Dolinskas C, Obrist W, Uzzell B (1981) Diffuse cerebral swelling following head injuries in children: the syndrome of “malignant brain edema”. J Neurosurg 54:170
Bruce DA, Raphaely RC, Goldberg AI, Zimmerman RA, Bilaniuk LT, Schut L, Kuhl DE (1979) Pathophysiology, treatment and outcome following severe head injury in children. Child's Brain 5:174
Bruce DA, Schut L (1980) The value of CAT scanning following pediatric head injury. Clin Pediatr (Phila) 19:719
Bruce DA, Schut L, Sutton LM (1983) Neurosurgical emergencies. In: Fleisher G, Ludwig S (eds) Textbook of pediatric emergency medicine. Williams and Wilkins, Baltimore, p 1012
Choi SC, Ward JD, Becker DP (1983) Chart for outcome prediction in severe head injury. J Neurosurg 59:294
Cold GE, Jensen FT (1980) Cerebral flood flow in the acute phase after head injury. Part 1: correlation to age of the patients, clinical outcome and localisation of the injured region. Acta Anaesth Scand 24:245
Cold GE (1981) Cerebral blood flow in the acute phase after head injury. Part 2: correlation to intraventricular pressure, cerebral perfusion pressure, PaCO2, ventricular fluid lactate, lactate/pyruvate ratio and pH. Acta Anaesth Scand 25:332
Conn AW, Edmonds JF, Barker GA (1979) Cerebral resuscitation in near-drowning. Pediatr Clin North Am 26:691
Cowan F, Thoresen M (1985) Changes in superior sinus blood velocities due to postural alterations and pressure on the head of the newborn infant. Pediatrics 75:1038
Dagi TF, Meyer FB, Poletti CA (1983) The incidence and prevention of meningitis after basilar skull fracture. Am J Emerg Med 1:295
Dhellemmes P, Lejeune JP, Christiaens JL, Combelles G (1985) Traumatic extradural hematomas in infancy and childhood. J Neurosurg 62:861
Donegan MF, Bedford RF (1980) Intraveously administered lidocaine prevents intracranial hypertension during endotracheal suctioning. Anesthesiology 52:516
Einhorn A, Mizrahi EM (1978) Basilar skull fractures in children. Am J Dis Child 132:1121
Fife D, Jagger J (1984) The contribution of brain injury to the overall injury severity of brain-injured patients. J Neurosurg 60:697
Gratz IR (1979) Accidental injury in childhood: a literature review on pediatric trauma. J Trauma 19:551
Griefenstein FE, Gegg WS (1980) Anesthesia in the presence of injuries to the cervical spine. In: Zauder, HL (ed) Anesthesia for orthopedic surgery. Davis, Philadelphia
Kennedy C, Sokoloff L (1957) An adaptation of the nitrous oxide method to the study of the cerebral circulation in children; normal values for cerebral blood flow and cerebral metabolic rate in childhood. J Clin Invest 36:1130
Kirsch JR, Traystman RJ, Rogers MC (1985) Cerebral flood flow measurement techniques in infants and children. Pediatrics 75:887
Kuhl DE, Alavia A, Hoffman EJ, Phelps ME, Zimmerman RA, Obrist WD, Bruce DA, Greenberg JH, Uzzell B (1980) Local cerebral blood volume in head-injured patients. J Neurosurg 52:309
Levin HS, Eisenberg HM (1979) Neuropsychological outcome of closed head injury in children and adolescents. Child's Brain 5:281
Lewelt W, Jenkins LW, Miller JD (1982) Effects of experimental fluid-percussion injury of the brain on cerebrovascular reactivity to hypoxia and to hypercapnia. J Neurosurg 56:332
Lewin S, Brettman LR, Holzman RS (1981) Infections in hypothermic patients. Arch Intern Med 141:920
Lutschg J, Pfenninger J, Ludin HP, Vassella F (1983) Brain-stem auditory evoked potentials and early somatosensory evoked potentials in neurointensively treated comatose children. Am J Dis Child 137:421
Mahoney WJ, D'Souza BJ, Haller JA, Rogers MC, Epstein MH, Freeman JM (1983) Long-term outcome of children with severe head trauma and prolonged coma. Pediatrics 71:756
Mayer T, Walker ML, Johnson DG, Matlak ME (1981) Causes of morbidity and mortality in severe pediatric trauma. JAMA 245:719
Mayer T, Walker ML, Shasha I, Matlak M, Johnson DG (1981) Effect of multiple trauma on outcome of pediatric patients with neurologic injuries. Child's Brain 8:189
Michenfelder JD (1984) Protecting the brain from ischemia and hypoxemia: can anything be done pharmacologically? In: ASA Refresher Courses 1984, No 118. American Society of Amesthesiologists, Park Ridge, Illinois
Milley JR, Nugent SK, Rogers MC (1979) Neurogenic pulmonary edema in childhood. J Pediatr 94:706
Miner ME, Kaufman HH, Graham SH, Haar FH, Gildenberg PL (1982) Disseminated intravascular coagulation fibrinolytic syndrome following head injury in children: frequency and prognostic implications. J Pediatr 100:687
Molofsky WJ (1984) Steroids and head trauma. Neurosurgery 15:424
Morray JP, Tyler DC, Jones TK, Stuntz JT, Lemire RJ (1984) Coma scale for use in brain-injured children. Crit Care Med 12:1018
Obrist WD, Langfitt TW, Jaggi JL, Cruz J, Gennarelli TA (1984) Cerebral blood flow and metabolism in comatose patients with acute head injury. J Neurosurg 61:241
Outwater KM, Rockoff MA (1984) Diabetes insipidus accompanying brain death in children. Neurology 34:1243
Pascucci RC (1985) Stabilization of the patient with head injury and multiple trauma. In: James HE (ed) Brain insults in infants and children: pathophysiology and management. Grune and Stratton, Orlando
Pascucci RC, Strauss W, Simpson GL, McIntyre KM, May HL (1984) Clinical death and resuscitation. In: May HL (ed) Emergency Medicine. Wiley, New York
Piatt JH, Schiff SJ (1984) High dose barbiturate therapy in neurosurgery and intensive care. Neurosurgery 15:427
Raimondi AJ, Hirschauer J (1984) Head injury in the infant and toddler; coma scoring and outcome scale. Child's Brain 11:12
Raju TNK, Vidyasagar D, Papazafiratou C (1980) Intracranial pressure monitoring in the neonatal ICU. Crit Care Med 8:575
Raphaely RC, Swedlow DB, Downes JJ, Bruce DA (1980) Management of severe pediatric head trauma. Pediatr Clin North Am 27:715
Rockoff MA (1985) Barbiturate therapy in head injury: when and how to employ it. In: James JE (ed) Brain insults in infants and children: pathophysiology and management. Grune and Stratton, Orlando
Ruben BH (1984) Intracranial Hypertension. In: Gallagher TJ (ed) Advances in Anesthesia. Year Book Medical Publishers, Chicago
Saunders ML, Miller JD, Stablein D, Allen G (1979) The effects of graded experimental trauma on cerebral flood flow and responsiveness to CO2. J Neurosurg 51:18
Schaible DH, Cupit GC, Swedlow DB, Rocci ML (1982) Highdose pentobarbital pharmacokinetics in hypothermic brain-injured children. J Pediatr 100:655
Schwartz JA, Baxter J, Brill DR (1984) Diagnosis of brain death in children by radionucleide cerebral imaging. Pediatrics 73:14
Shapiro HM, Wyte SR, Loeser J (1974) Barbiturate-augmented hypothermia for reduction of persistent intracranial hypertension. J Neurosurg 40:90
Shapiro K (ed) (1983) Pediatric head trauma. Futura Publishing, Mount Kisco, New York
Swedlow DB, Schreiner MS (1985) Management of Reye's syndrome. Crit Care Clin 1:285
Steen PA, Gisvold SE, Milde JH, Newberg LA, Scheithauer BW, Lanier WL, Michenfelder JD (1985) Nimodipine improves outcome when given after complete cerebral ischemia in primates. Anesthesiology 62:406
Strickbine-van Reet P, Glaze DG, Hrachovy RA (1984) A preliminary prospective neurophysiological study of coma in children. Am J Dis Child 138:492
Teasdale G, Galbraith S (1981) Head trauma and intracranial hemorrhage. In: Grenvik A, Safar P (ed) Brain failure and resuscitation. Churchill Livingstone, New York
Todd MM, Shapiro HM, Obrist WD (1981) Cerebral flood flow measurements in the critically ill patient. In: Grenvik A, Safar P (ed) Brain failure and resuscitation. Churchill Livingstone, New York
Trunkey DD (1983) Trauma. Sci Am 249:28
Turner E, Hilfiker O, Braun U, Wienecke W, Rama B (1984) Metabolic and hemodynamic response to hyperventilation in patients with head injuries. Intensive Care Med 10:127
Walker ML, Storrs BB, Mayer T (1984) Factors affecting outcome in the pediatric patient with multiple trauma. Child's Brain 11:387
Zimmerman RA, Bilaniuk LT (1981) Computed tomography in pediatric head trauma. J Neuroradiol 8:257
Zimmerman RA, Bilaniuk LT, Bruce DA, Dolinskas C, Obrist W, Kuhl D (1978) Computed tomography of pediatric head trauma: acute general cerebral swelling. Radiology 126:403
Jennett B, Teasdale G (1977) Aspects of coma after severe head injury. Lancet I:878
Rogers MC, Traystman RJ (1985) An overview of the intracranial vault: physiology and philosophy. Crit Care Clin 1:196
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Pascucci, R.C. Head trauma in the child. Intensive Care Med 14, 185–195 (1988). https://doi.org/10.1007/BF00717985
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DOI: https://doi.org/10.1007/BF00717985