A Clinical Observation on Head Injuries in Infants and Children.

Park, Chong Woon; Ha, Young Soo

Original Article

Journal of Korean Neurosurgical Society 1988;17(6): 1291-1302.

Department of Neurosurgery, In Ha University, College of Medicine, Korea.

ABSTRACT

A clinical analysis was carried out with 108 cases of head injuries under 15 years of age, admitted at the Department of Neurosurgery, In Ha University Hospital in 11/2 years between Jan., 1987 and June., 1988. The material was classified into three groups according to main lesions, i.e. 1) simple cerebral contusion without skull fractures. 2) various types of skull fractures. 3) intracranial hemorrhagic lesions, representing such lesions as follows:a) epidural hematoma b) subdural hematoma. c) intracerebral hematoma, intraventricular and subarachnoid hemorrhage. The results were as follows: 1) The age incidence was greatest in 7 years of age, and 51 cases(47.2% of total) were included in the age group between seven and ten. 2) The accident occurred mostly between March and May. 3) Males outnumbered females by almost 2:1. 4) The head injuries were caused by traffic accident(52 cases:48%), fall down(47 cases:43%), hit(9 cases:9%). 5) In clinical picture, vomiting(57 cases:53.7%) and convulsion(8 cases:7.4%) and neck sprain(55 cases:50.9%) were developed and at accident, forty seven cases(43.5%) had the history of loss of consciousness. 6) Of the patients between GCS 5 and 14, 57 cases(92%) were included in the simple cerebral contusion. Of the patients below GCS 13, 45 cases(98%) were included in the skull fracture or intracranial hemorrhagic lesions but eighteen cases of the patients below GCS 13 were taken operation. 7) In skull fracture patients, the location in the order of frequency was parietal, occipital, temporal and frontal bone. The vault skull fracture was about twelfth fold as frequent as basal skull fracture and the incidence of linear skull fracture was higher than that of depressed skull fracture, the ratio being about 7:1. 8) Among the intracranial hemorrhagic lesions, the epidural hematoma was most common lesion. Twenty one cases(81%) of the patients with intracranial hemorrhagic lesions were accompanied by skull fracture but of the patients with skull fracture, 21 cases(47%) were accompanied by intracranial hemorrhagic lesions. Seventeen cases(46%) with the linear skull fracture involved in the intracranial hemorrhagic lesions. 9) Contre coup injury was developed in 6 cases(12%) and Lucid interval was observed in 4 cases(5%) of the cases with intracranial hemorrhagic lesions. 10) Associated injuries were found in about 27% of the total patients. The frequent ones were clavicle fracture, femur fracture, tibia/fibular fracture, pelvic fracture and so on order. 11) Sequelae were noticed in about 20% of the total patients. The most frequent one was post traumatic syndrome. 12) The period of hospitalization was about 2 weeks on an average in non-surgical cases(83%) and 4-6 weeks on an average in surgical cases(70%).