Al Daoud Fadi, Drolet Anne, Carto Chase, Debessai Haben, Daswani Gul Sachwani
1 Hurley Plaza, 7 B Trauma Services, Flint, MI, 48503, USA.
Ann Med Surg (Lond). 2018 Sep 25;35:86-89. doi: 10.1016/j.amsu.2018.09.021. eCollection 2018 Nov.
Traumatic Brain Injuries (TBIs) can range from mild to severe, and may result in increased intracranial pressure (ICP). Increased ICP causes hallmark physical signs, such as diaphoresis, emesis, fixed pupils, and altered mental status. Monitoring the patient's score on the Glasgow Coma Scale (GCS) and cranial CT scans are routine measures used in clinical practice to monitor the development of a TBI.
A 6-year-old male fell off his father's shoulders and subsequently presented to ED for suspected head trauma. He was transferred to our Level 1 Trauma Center after a head CT scan demonstrated a subdural hematoma. His GCS score remained 15. The next day he began to have episodes of apnea and desaturation. Further imaging indicated expansion of the hematoma with a 5mm midline shift. He remained consistently alert and a neurological exam revealed cranial nerves to be grossly intact. Increased ICP was reduced with several days of hypertonic saline treatment without surgical intervention.
TBIs can have long-lasting effects in pediatric patients and are typically assessed using both diagnostic imaging and clinical judgment. CT scans are used to assess for hematoma development, while loss of consciousness (LOC) and altered mental status are standard clinical diagnostic indicators of increased ICP. This patient remained alert with a GCS score of 15, although he had clinical signs of increased ICP including apnea and bradycardia with a midline shift confirmed on imaging.
While GCS is an important prognostic indicator in TBI, patients should still be monitored to assure resolution of all symptoms.
创伤性脑损伤（TBI）的严重程度不一，可能导致颅内压（ICP）升高。颅内压升高会引发典型的体征，如出汗、呕吐、瞳孔固定及精神状态改变。监测患者的格拉斯哥昏迷量表（GCS）评分和进行头颅CT扫描是临床实践中用于监测创伤性脑损伤进展的常规措施。
一名6岁男性从父亲肩上跌落，随后因疑似头部外伤被送往急诊科。头颅CT扫描显示硬膜下血肿后，他被转至我们的一级创伤中心。他的GCS评分仍为15分。第二天，他开始出现呼吸暂停和血氧饱和度下降的情况。进一步影像学检查显示血肿扩大，中线移位5mm。他始终保持清醒，神经系统检查显示颅神经大致完好。经过几天的高渗盐水治疗，颅内压升高的情况得到缓解，无需手术干预。
创伤性脑损伤在儿科患者中可能产生长期影响，通常通过诊断性影像学检查和临床判断进行评估。CT扫描用于评估血肿的发展情况，而意识丧失（LOC）和精神状态改变是颅内压升高的标准临床诊断指标。尽管该患者GCS评分为15分且保持清醒，但他有颅内压升高的临床体征，包括呼吸暂停和心动过缓，影像学检查证实存在中线移位。
虽然GCS是创伤性脑损伤的重要预后指标，但仍应对患者进行监测，以确保所有症状得到缓解。
