Management of the Child With Severe Brain Injury

Delayed and Progressive Brain Injury in Children and Adolescents with Head Trauma

“…Autopsy results show that delayed ischemia and swell ing complicate CHI in children in much the same way as in adults [35], Delayed hemorrhages can be seen on serial CT scans, the diagnostic yield depending on the frequency of studies [50], Many biochemical and microvascular events responsible for secondary cerebral injury in chil dren have been described [51,52], and explanations have been advanced for the vulnerability of the pediatric brain to such insults [53].…”

“…Unlike our experience in adults, the present study finds a significant association between delayed injury and subarachnoid hemorrhage, rather than subdural hematoma. Injuries to other organs can have a profound influence on outcome from pediatric CHI [12], the severity of injury contribut ing more than the specific organ system involved [54], Hypoxia and especially shock worsen outcome [55], per haps by initiating the biochemical and microvascular cas cades of delayed cerebral insults [51,53].…”

“…The cerebrospinal fluid of brain-injured infants and children has anticoagulant properties, even in the absence of systemic coagulopathy [62][63][64], suggesting a central process is involved. There have been suggestions that coagulation treatment may improve the outcome of CHI in children [51,60], but no data as yet support this hypothesis.…”