Brain concussion at children – the easy degree of ChMT which is followed by insignificant functional disorders of passing character without violation of integrity of bones of a skull. Brain concussion at children proceeds with short-term violation a soznayoniya, vomiting, pallor of integuments which are replaced further by a headache, dizziness, slackness, noise in ears, eyeball pain. At suspicion of concussion consultations of the traumatologist and the neurologist, carrying out NSG, EhoEG, EEG, skull X-ray analysis are shown to children; according to indications of KT (MPT) of a brain, a lyumbalny puncture. Medical tactics at brain concussion at children includes hospitalization, rest, a local hypothermia, a dehydrational, sedative, nootropic terayopiya.
Brain concussion at the child
Brain concussion at children – a kind of the closed craniocereberal trauma with the reversible changes in TsNS which are shown all-brain and unstable focal neurologic symptomatology. Concussion of a brain belongs to the easiest and widespread types of damages to children's traumatology which is annually diagnosed for 120 thousand Russian children. Among all ChMT 90% of cases fall to the share of concussion at children. Statistically, the greatest number of cases of concussion of a brain at children occurs in age groups up to 5 years and 15 years are more senior.
The originality of a current and outcome of concussion of a brain at children is connected with the fact that influence of mechanical energy is the share of the growing and developing brain. On the one hand, plasticity of a children's brain causes high extent of compensation; with another - failure of functions of a brain even not always takes place in children's age completely. It is known what in the remote period (in 6 months - 3 years after brain concussion) at 30% of children develops, the so-called, postkommotsionny syndrome which is characterized by dizziness, headaches, violation of memory and attention, apathy, uneasiness, emotional lability, problems with a dream.
The brain concussion reasons at children
The circumstances leading to concussion at children are specific to various age groups. Injuries of the head of children of the first year of life are a consequence of oversight of adults. Usually babies get brain concussion owing to falling from a pelenalny little table, from a bed, a carriage, from hands of parents, etc. After a year when the kid starts walking independently, as the main reason for concussion of a brain at the child falling from height of own growth acts. Injuries of preschool children are connected with falling from hills, a swing, ladders, from windows, blows to the head etc. School students and teenagers, as a rule, get brain concussion because of own carelessness and imprudence – when falling from roofs, trees, occupations injury-causing sports, in fights and so forth.
High prevalence of ChMT at children's age is promoted by the increased physical activity and inquisitiveness of children and at the same time – the lowered sense of danger, imperfection of motility and coordination. Considering rather big weight of the head of children and backwardness of skill of an insurance hands, the majority of falling at children's age comes to an end with a head injury. It should be noted that brain concussion at children not always manages to be revealed at once: the adults (nurses, neighbors, relatives) who are looking after the small child, and also children are more senior injuries can suppress consciously from parents the fact.
Besides, brain concussion at children can occur also without mechanical injury of a skull. This phenomenon developing at impact on a body of sharp acceleration or braking in children's surgery and pediatrics received the name of a syndrome of "the vstryakhnuty child". This phenomenon is most characteristic of children of younger age and can arise owing to excessively intensive rocking babies, ill-treatment of the child from the adult, jumps from height on legs etc.
Patomorfologichesky changes at brain concussion at children come to light only at the molecular and cellular level. For an explanation of the frustration arising at the same time it is put forward a number of theories.
According to the vibration molecular concept, the mechanism of damages of cells of a brain is connected with the molecular changes caused by vibration at the time of injuring. From force place of application, by the principle of counterstroke, vibration extends through all brain fabric to the opposite side.
The vasomotorial theory as the main mechanisms of concussion of a brain considers the disorder of activity of the vasomotorial centers leading to violation of brain blood circulation (a vascular spasm – brain ischemia - long stagnant hyperaemia).
According to the hydrodynamic theory, the blow at the time of a trauma causes the movement of cerebrospinal fluid which sharply moves from side ventricles of a brain to III and IV, causing their stretching, a bruise and irritation of the nearby centers.
Classification of concussion of a brain at children
Brain concussion at children belongs to the closed ChMT (along with a bruise and a sdavleniye of a brain), being its easiest form.
At the same time, the clinical course of concussion of a brain at children can also have easy (I), average weight (II) and heavy (III) degrees of expressiveness. At the I degree episodes of loss of consciousness are absent, and symptoms remain no more than 15 minutes. At the II degree there is also no consciousness loss, however symptoms are noted for more than 15 minutes. Concussion of the III degree at children is characterized by loss of consciousness during any time.
Brain concussion symptoms at children
At children of chest age recognition of concussion of a brain is difficult in connection with not specificity of symptomatology. Consciousness, as a rule, is not lost, however kids have plentiful vomiting when feeding, vomiting, causeless crying and concern, a sleep disorder and appetite.
At more senior children directly after a trauma short-term violation of consciousness (devocalization, a sopor), pallor of integuments, cold sweat is noted. Developing of vomiting which at children up to 3 years usually happens repeated is characteristic. After consciousness clearing the main complaints of the child include instructions on a headache and dizziness, a sonyolivost and weakness, a ring and noise in ears, pressure and eyeball pain. After brain concussion at children loss of memory on the events which were preceding a trauma or taking place after it (retrograde and anterograd amnesia) can be noted.
At brain concussion at children the sharpening of light sensitivity and to sounds, arterial hypotonia, lability of pulse, temperature increase of a body can take place. After blow the post-traumatic blindness can be noted by a nape. At survey of the child it is possible to notice glazodvigatelny frustration: , look paresis, the dispersing squint, an anizokoriya, etc.
At brain concussion the subjective symptomatology and objective signs can occur at children in various combinations. The age of the child is younger, the it is more difficult to reveal at it brain concussion symptoms.
Diagnosis of concussion of a brain at children
Except glazodvigatelny violations, at children with concussion of a brain the smoothness of a nasolabial fold, deviation of language, muscular hypotonia, an anizorefleksiya, existence pronounced palmar a reflex comes to light. Except the general and neurologic survey, quite often there is a need for performing the additional diagnostics directed, first of all, to an exception of heavier injuries of a brain.
For children of the 1-2nd year of life with brain concussion an obligatory research is carrying out a neyrosonografiya through a fontanel. Ultrasonography allows to visualize well brain substance, to reveal symptoms of hypostasis, hemorrhage and intra cranial hematomas. The ekhoentsefalografiya allows to receive indirect information on a condition of substance and ventricular system of a brain. The electroencephalography is applied to assessment of weight of concussion of a brain at children.
For the purpose of an exception of cracks and fractures of bones of a skull and cervical vertebras the X-ray analysis of a skull and a X-ray analysis of cervical department of a backbone is carried out. In the presence of indications the algorithm of inspection is supplemented with KT of a skull and KT of a brain, brain MRT, a lyumbalny puncture. At data acquisition for a fracture of cranial bones, intra cranial hematomas, and also when progressing symptomatology the child has to be consulted by the neurosurgeon.
Need of differential diagnosis of concussion of a brain at children arises with intra cranial patrimonial injuries at newborns, meningitis, encephalitis, a bruise and a sdavleniye of a brain, an open craniocereberal trauma.
Treatment of concussion of a brain at children
Children with concussion of a brain need hospitalization in office of children's traumatology for carrying out necessary volume of diagnostics and dynamic observation. In the presence of damages of soft tissues of the head (wounds, grazes, bruises) their primary surgical processing is made. To the child with concussion of a brain the bed rest, psychoemotional rest, a local hypothermia (applying of a bubble with ice to the head), inhalations of the moistened oxygen, hyperbaric oxygenation is appointed.
Medicamentous therapy of concussion of a brain at children is directed to prevention of hypostasis of a brain, rebalancing between proyotsessa of braking and excitement, improvement of metabolic and biopower processes in a brain. Nootropic medicines and vitamins are for this purpose applied diuretic (acetazoleamide, furosemide), sedative (a valerian, phenobarbital) (glycine, group B vitamins, ascorbic, gopantenovy and glutamic acids, etc.). At the expressed headaches analgetics are appointed, at nausea – antiemetic medicines.
In case of an exception of heavy injuries of a brain and regression of symptomatology the child in 7-10 days can be written out on an out-patient aftercare within 1,5-2-h more weeks. Visit of child care facility is allowed after control survey of the neurologist with release of the child from physical activities for 1-2 months.
The forecast and prevention of concussion of a brain at children
Brain concussion at children usually does not involve significant complications. The most frequent a consequence of concussion of a brain are the postkommotsionny syndrome, an asthenic syndrome, vegeto-vascular dystonia; at the medium-weight and heavy closed ChMT post-traumatic epilepsy can develop. The timely address to the doctor and a full course of medicamentous therapy allow to exclude the remote consequences of concussion of a brain at children.
Prevention of concussion of a brain demands constant and vigilant parental control for the child from small children. Children of advanced age need to explain importance of observance of traffic regulations, care in games, protection of the head with a helmet at occupations injury-causing sports. At any recorded injury of the head it is necessary to show the child to the expert who will resolve an issue of expediency of further inspection and treatment.