Pediatric emergency medicine trisk 0821 0821
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several hours, however, in a small number of patients symptoms may persist for
days or weeks. For more details please see Chapter 113 Neurotrauma .
Posttraumatic Seizure
Posttraumatic seizures occur in approximately 1% of children with head trauma.
In a large prospective study about 15% of these children had TBI noted on CT
(higher among those with longer seizures and seizures occurring a longer interval
after the traumatic event). More than 25% of children with posttraumatic seizures
and TBI on CT required neurosurgical intervention. However, among patients
with a GCS of 15 on presentation and a normal CT, the incidence of recurrent
seizure is extremely low, with none requiring neurosurgery. A careful history may
be needed to distinguish posttraumatic seizures from the more benign concussive
convulsions, which are characterized by tonic–clonic movements that occur
within seconds of head strike.
Cerebral Contusion
Cerebral contusion is a bruising or crushing of brain and often results from blunt
head trauma. The site of contusion may be a “coup” lesion, with the injured
cerebral cortex directly beneath the site of impact (with or without skull fracture),
or a “contrecoup” lesion, with damage opposite the site of impact; the contusion
is demonstrable by CT scan. Children with cerebral contusion may have had LOC
(not imperative), may show a depressed level of consciousness or symptoms of
vomiting or headache, and may have focal neurologic signs or seizures.
Epidural Hematoma
EDH is a collection of blood between the skull and the dura. An overlying
fracture is present in the majority of cases, and, depending on the location and
vascular structure involved, the hemorrhage may be of arterial or venous origin;
injury to the middle meningeal artery is frequently responsible for temporal EDH.
The classic pattern of a “lucid interval” between initial LOC and subsequent
neurologic deterioration occurs only in a minority of children with EDH;
furthermore, patients may occasionally develop EDH after relatively “minor”
trauma with no history of LOC. Although many children present with marked
lethargy, focal neurologic signs, or a clinical pattern consistent with temporal lobe
herniation as the hematoma expands, some children may be alert with a nonfocal
neurologic examination and may have symptoms only of headache or persistent
vomiting; nevertheless, rapid deterioration can ensue.
Subdural Hematoma
