The Unique Features of Traumatic Brain Injury in Children. Review of the Characteristics of the Pediatric Skull and Brain, Mechanisms of Trauma, Patterns of Injury, Complications, and their Imaging Findings—Part 2

Abstract

Traumatic brain injury (TBI) is a major cause of morbidity and mortality in children. The unique biomechanical, hemodynamical, and functional characteristics of the developing brain and the age-dependent variance in trauma mechanisms result in a wide range of age specific traumas and patterns of brain injuries. Detailed knowledge of the main primary and secondary pediatric injuries, which enhance sensitivity and specificity of diagnosis, will guide therapy and may give important information about the prognosis. In recent years, anatomical but also functional imaging methods have revolutionized neuroimaging of pediatric TBI. The purpose of this article is (1) to comprehensively review frequent primary and secondary brain injuries and (2) to give a short overview of two special types of pediatric TBI: birth related and nonaccidental injuries.

Biomarkers of mild traumatic brain injury in cerebrospinal fluid and blood

“…13 Another important consideration affecting the patient’s recovery after mild TBI is their age, since the developing brain seems to be more vulnerable to repeated concussions than is the adult brain, 29 owing to differences in the degree of myelination, volume ratio of brain to water, elastic properties, and blood–brain barrier (BBB) integrity. 30,31 This knowledge, in conjunction with available biomechanical, radiological and clinical data, 32,33 should be communicated to parents with the aim of discouraging the participation of children in contact sports that target the head.…”

Influences of Developmental Age on the Resolution of Diffuse Traumatic Intracranial Hemorrhage and Axonal Injury

“…Because we used a non-impact TBI model, we did not expect epidural hemorrhage to form after injury. 30 To account for any potential ICH that may have been caused by insertion of the intracranial monitoring probes, we acquired the ICH percentages of four sham five-day-old piglets that also had microdialysis and thermal diffusion probes inserted into the brain. The average sham percentages for each region and the whole cerebrum were subtracted from the corresponding percentages of the RNR piglets with intracranial monitoring.…”

How do we Handle Traumatic Pediatric Carotid Artery Dissection?

“…It is stated that the most vulnerable segment of the carotid artery is the most distal cervical segment before entering the carotid canal at the skull base. The mechanism was explained as: the stretching of the artery at the proximal cervical vertebral column with hyperflexion or extension or rotation of the neck causes intimal tears in the artery wall [1,2,6]. Subintimal tear in the arterial wall causes stenosis and thromboembolism; on the other hand, sub adventitial tear causes pseudo aneurysm formation and potential rupture [7].…”

“…These cases also have drawn attention due to concomitant severe damage to the regional vascular structures such as carotid artery [1,2]. In some cases, especially with skull base fractures and cervical vertebral column trauma; carotid artery dissections at the cervical segment can occur [3,4].…”