Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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Our aim was to analyze prognostic factors and their association with outcome among children with severe head injury. ⋯ In addition to GCS, types of trauma and brain lesion, hypoxia and hypotension, hemocoagulative disorders (DIC), hyperglycemia and early post-traumatic seizures are predictors of GOS. A knowledge of these prognostic factors and the correct management of children with severe head injury helps clinicians to improve outcome and to reduce morbidity and mortality.
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Cerebrospinal fluid hydrothorax is reported as a rare complication of ventriculoperitoneal (VP) shunt. A 16-month-old boy known to have congenital hydrocephalus and a Dandy-Walker cyst presented with serious respiratory distress. Examination revealed right pleural effusion and congested throat. ⋯ Changing the VP shunt for a ventriculo-atrial shunt resulted in immediate (within 1 day) complete disappearance of the pleural effusion and of the patient's chest symptoms. Probable causes of this rare complication are discussed, and attention is drawn to the possibility of its appearance and early recognition. Intraperitoneal injection of contrast material followed by X-ray examination of fluid in the chest is a simple, safe, and reliable method of diagnosis when it is suspected.
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The formation of an epidural hematoma from an eosinophilic granuloma of the skull is an exceptional occurrence. A 9-year-old boy presented with severe headache, somnolence and vomiting following a minor head injury. ⋯ A neoplasm and an epidural hematoma were removed at operation. Histopathological study of the excised mass confirmed the diagnosis of eosinophilic granuloma.
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Neurotrauma is one of the most important causes of death in the pediatric age group. Head injury is responsible for both primary and secondary brain damage. The outcome of children with brain injury depends on the nature of the primary damage and on how well secondary brain damage can be limited. Appropriate critical care management at the scene and in hospital can prevent secondary brain damage that would otherwise result from cerebral reactions. Hypoxia and hypotension are major early complications of aggravation of secondary brain damage that are amenable to emergency maneuvers at the scene. In the literature, the influence of initial critical care management and early complications on the outcome of children with severe head injury is not clearly documented. ⋯ Our results confirm the need for a precise treatment strategy for the initial management of children with neurotrauma to decrease the incidence of secondary brain damage attributable to hypoxia and hypotension.
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In the present study, we compared ventricular pressures (VP) and the progression of ventricular enlargement in a new experimental neonatal hydrocephalus model, to gain an understanding of how communicating hydrocephalus progresses. ⋯ In the 1st and 2nd months VSIs were significantly higher than in control rats on the 15th day after kaolin administration. VP on the 15th day was significantly increased compared with that in control rats. VP in the 1st month was still high, but had subsided. In the 2nd month VP was not increased over control. In the late stages, the progression of infantile communicating hydrocephalus is not related to VP levels.