Recovery from mild head injury in children, particularly when post-traumatic amnesia persists for less than 24 hours, is generally complete. Neuropsychological testing 1 year after injury demonstrates no difference between mildly injured and age-matched uninjured controls. In the short term, however, many children may suffer from 'post-concussive syndrome.' Headaches, emotionality, impulsiveness, in-attentiveness and poor school performance may occur for as long as 3 to 6 months after injury. Neuropsychology follow-up visits are helpful in counseling parents and guiding home and school interventions during this time period.
Recovery after moderate or severe head injury in children is more variable and difficult to predict. Approximately 75% of children survive severe head injury and over 40% experience a good long-term outcome: normal neurological function or independent living with limited neurological deficits. Several categories of children, however, have a grim prognosis for neurological development leading to independent function: severely injured infants (including victims of shaking-impact syndrome),
children with an initial GCS of less than 5, children suffering from traumatic cardiac arrest, children with extensive Duret hemorrhages and/or cortical and subcortical T2 hyperintensities on MRI imaging, children with prolonged systemic hypotension after injury, and children with prolonged and severe intracranial hypertension (>40 cm H2O). Usually, a combination of the above findings is present in children with poor or vegetative outcomes.
Careful neurological follow-up is necessary for the first year after a severe head injury in children. Various treatable complications of head injury may develop during this interval. In infants, growing skull fractures may appear and result in cosmetic deformity, seizures, CSF leak or new neurological deficit (see above). Post-traumatic seizure disorder will occur in roughly 5% of severely head injured children. Early use of anti-convulsant medication after head injury does not alter the risk of developing a persistent seizure disorder. However, recognition and treatment of post-traumatic epilepsy will improve the ultimate outcome. Finally, occasional cases of post-traumatic hydrocephalus or subdural hygroma will cause delayed neurological deterioration. Diagnosis and surgical treatment of these lesions may dramatically improve outcome.
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