What are the Risks of Pediatric Brain Injury?

What are the Risks of Pediatric Brain Injury? How Can Brain Function Recovery be Facilitated After Brain Injury?

Head injuries among children are quite common, ranging from mild cases that lead to concussions to severe cases that result in brain contusions. Patients with concussions may exhibit symptoms such as pale complexion and temporary loss of consciousness. In older children, ongoing symptoms can include persistent headaches, vomiting, dizziness, heightened anxiety, and retrograde amnesia. Even when the symptoms of brain trauma seem to have disappeared, the lingering effects can still persist. I recall a case of a child with a head injury who experienced a grand mal seizure half a month after the trauma, enduring continuous convulsions for 5 hours. The child was admitted to the hospital in a status epilepticus, administered diazepam intravenously to control seizures, and then maintained on intramuscular luminal. The child regained consciousness after 3 hours. Recent research indicates that the developing brains of children are particularly sensitive to mild brain injuries. Roughly two weeks after a mild brain injury, structural changes in brain white matter begin to occur. Even if the symptoms have disappeared, these changes can continue for up to three months. This discovery is of significant importance, underscoring the need for caution when children with brain injuries resume physical activity to prevent recurrent brain trauma. To prevent accidents, mild brain injuries should be examined using magnetic resonance imaging (MRI) to detect minor lesions, such as tiny hemorrhages or linear-shaped lesions indicative of brain vascular damage. Although the symptoms in such patients might not be severe, the MRI can provide precise information about the size and location of brain injury lesions, guiding treatment objectives. For children with brain injuries, advanced imaging techniques should be employed to assess post-concussive brain tissue recovery after the symptoms of concussion have subsided. In some cases, diffusion tensor imaging might be necessary to examine brain white matter. Follow-up observation and cognitive testing alongside repeat brain imaging should be conducted over a period of four months.

One must remain vigilant regarding the latent dangers during the period of consciousness following brain trauma. Severe head trauma can cause the brain to shake, leading to transient consciousness impairment (coma or confusion), followed by rapid awakening (middle awakening period). If head trauma results in extradural hematoma (bleeding between the skull and dura mater) and the hematoma compresses brain tissue, the patient might lapse back into coma. The duration of the middle awakening period depends on the extent and speed of bleeding. Statistics show that 90% of patients experience the middle awakening period within 24 hours, though it might extend for a longer duration in some cases. Close observation is crucial for children with head trauma. If there is suspicion of brain contusion or intracranial hemorrhage, a head CT scan should be promptly conducted to initiate effective interventions.

Cognitive ability may be affected after pediatric brain injury, with mild traumatic brain injuries resulting in long-term consequences for cognitive functions. Approximately 15% to 20% of children with brain injuries suffer from attention deficit, memory decline, poor language skills, and delayed motor skills, which usually appear within two years after the brain injury. Behavioral symptoms resembling mental illness can manifest following pediatric brain injury, and these symptoms tend to diminish significantly during the recovery phase.

Concussions typically do not require specific treatment and usually resolve with a week of bed rest. Most patients recover within two weeks, with a favorable prognosis. Symptomatic treatment may include pain relief, sedatives, and medications to improve autonomic nervous system function, while minimizing external stimuli. Sedatives should be chosen in a way that does not hinder the observation of vital signs.

For children with concussions, observation in the hospital for 24 to 48 hours is imperative. Monitor changes in consciousness, pupil dilation, limb movement, and vital signs closely. Conduct necessary examinations based on the condition to avoid overlooking other types of cranial and brain injuries. Children who experience frequent vomiting might require intravenous fluid replacement to prevent dehydration and electrolyte imbalance.

Neurological research demonstrates that brain function can be restored to normal through active treatment after brain injury. A recent study suggests that if brain neurons are undamaged in pediatric brain trauma, recovery can be achieved through targeted neural transplantation using a small amount of new brain tissue. After neural transplantation, stimulated brain tissue generates new neural distribution, leading to restoration of movement, stereoscopic vision, and spatial perception functions.

Research has indicated that persistent functional impairments following brain injury are primarily due to damaged connections between the brainstem and cerebral hemispheres. This damage can be treated using a peptide substance called "neurotrophic factors derived from the brain," which plays a significant role in forming neural pathways and promoting functional recovery. Interaction between undamaged neural networks and synapses of newly generated neurons allows for restoration of neural functions (such as coordinated movement and spatial orientation).

It's important to note that while moderate to severe pediatric brain injuries may lead to secondary functional impairments, affecting the child's quality of life, these conditions often begin to improve around the age of 2 to 3 years.