Course and prognosis

The level of consciousness, degree of somatic injury, extent and duration of post-traumatic amnesia, severity of head injury, and degree of neurocognitive dysfunction in the early post-trauma period are important in determining outcome. Children who experience severe traumatic brain injury usually follow a predictable postoperative course/48) As previously noted, landmarks for recovery are associated with the time of emergence from coma and the time of emergence from post-traumatic amnesia. The emergence from coma is most often defined as the point at which the patient is able to follow simple verbal commands. Concurrently, visual tracking of objects in the environment may be observed.

Post-traumatic amnesia ends when the child is able to form new memories. The frequency of post-traumatic amnesia is probably related to concurrent injury to the temporal lobes associated with the head trauma. However, older memories may be recalled that do not involve the temporal lobe. The hippocampus has a central role in the formation of new memories. Besides recovery from post-traumatic amnesia, another form of memory loss—retrograde amnesia—for events that took place before the accident, typically becomes shorter and shorter during the recovery process. It is important to remember that children with severe head trauma will rarely have specific memories of the accident itself. Overall, the most important milestones in recovery for future outcome are the length of coma and the duration of post-traumatic amnesia.

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