ABSTRACT
Neurotrauma is one of the leading causes of morbidity and mortality in children. Most traumatic brain injury (TBI) occurs secondary to motor vehicle collisions, falls, assaults, recreational activities, and abuse. Larger head-to-body-size ratio and thinner cranial bones increase the susceptibility to head trauma in children. Limited subarachnoid space, less myelinated neural tissue, increased cerebral metabolic rate of oxygen consumption, and narrow autoregulatory curve of mean arterial pressure further increases the vulnerability to damage. Spinal cord injury (SCI) is relatively rare in children (1.5%). Approximately 72% of spinal injuries in children under 8 years of age occur in the cervical spine. Ligamentous laxity, shallow and angled facet joints, underdeveloped spinous processes, physiologic anterior wedging of vertebral bodies, incomplete ossification of the odontoid process, a relatively large head, and weak neck muscles are a few important factors that predispose to instability of the pediatric cervical spine. Early diagnosis, aggressive initial resuscitation, prevention of secondary injuries, appropriate neuromonitoring, and a multidisciplinary rehabilitation approach forms the mainstay of management modalities in neurotrauma. The next evolution in neurotrauma care may be toward adding more sophisticated management algorithms into the care of patients, based on individual patients’ unique pathophysiology of injury.
