Best Pediatric Brain Injury Treatment in Delhi

Best Traumatic Brain Injury Treatment in Delhi

What is Traumatic Brain Injury in Paediatrics ?

Traumatic Brain Injury (TBI) in paediatrics is a significant concern, being a leading cause of death and disability in children. It is crucial to understand that TBI in children differs from adults due to age-related anatomical and physiological differences, varying injury patterns based on the child’s physical abilities, and challenges in neurological evaluation.

TBI is defined as an injury to the head and underlying brain caused by an external force, leading to an impairment in brain function.
Severity is typically classified as mild, moderate, or severe based on the Glasgow Coma Scale (GCS):-
- Mild TBI (concussion): GCS score of 14-15. Most children with mild TBI recover without long-term problems.
- Moderate TBI: GCS score of 9-13.
- Severe TBI: GCS score of 3-8. Children with severe TBI are at high risk of mortality and neurological morbidity, and may experience lifelong problems.

Causes

Common causes of pediatric TBI include:
- Falls (especially in younger children)
- Motor vehicle collisions
- Sporting events
- Non-accidental trauma (NAT) or child abuse, which should be suspected in cases of multiple injuries with different healing stages, retinal hemorrhage, or bilateral chronic subdural hematomas in young children.

Pathophysiology-

TBI involves a primary injury occurring at the moment of impact (direct hit or acceleration-deceleration mechanisms).
This is followed by secondary damage due to various factors such as:
- Intracranial hematomas (bleeding within the skull)
- Ischemia (reduced blood flow)
- Edema (swelling)
- Vasospasm (narrowing of blood vessels)
- Hypoxemia (low oxygen levels)
- Cellular and molecular damage

Symptoms and Signs

Symptoms vary widely depending on the child’s age and the severity of the injury.

General symptoms (can apply to all severities):
- Headache
- Nausea/vomiting
- Fatigue or drowsiness
- Irritability or abnormal behavior
- Dizziness or loss of balance
- Sensitivity to light or sound
- Memory or concentration problems
- Changes in sleep patterns
- Blurred or double vision
- Ringing in the ears (tinnitus)
- Changes in taste or smell
Symptoms more indicative of moderate to severe TBI:
- Prolonged loss of consciousness (ranging from minutes to hours)
- Persistent or worsening headache
- Repeated vomiting
- Convulsions or seizures
- Dilation of one or both pupils
- Clear fluid draining from nose or ears
- Inability to awaken from sleep
- Weakness or numbness in limbs
- Slurred speech
- Trouble walking
Symptoms in infants/young children (who may not be able to express themselves)
- Changes in eating/nursing habits
- Unusual irritability or inconsolable crying
- Drowsiness and inattention
- Changes in sleep habits
- Loss of interest in favorite toys/activities
- Loss of acquired language or new skills (e.g., toilet training)
- Scalp or head swelling

Diagnosis-

Clinical assessment using the Paediatric Glasgow Coma Scale (PGCS) is crucial for assessing consciousness and determining severity.
Diagnostic imaging (e.g., CT scan, MRI) helps to identify brain damage, hematomas, and other complications.

Management

Acute management focuses on close monitoring and control of cerebral circulation and intracranial pressure, especially in moderate to severe TBI.
Rehabilitation is often necessary for children with moderate to severe TBI to address long-term physical, cognitive, and behavioral issues. This can involve:-
- Physical therapy for motor impairments
- Occupational therapy for daily living skills
- Speech and language therapy for communication difficulties
- Neuropsychological assessment and support for cognitive and emotional challenges.
School reintegration and support are vital as children may experience difficulties with attention, concentration, memory, and coping with stress.

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