【体外膜肺ECMO精品课件】 head injuries.pptVIP

The head injured child What tests? When? Why Ciara Earley VFPMS Consultant VFPMS Seminar June 2nd 2014 Outline Types of head injuries Subdural haematomas Controversies in AHT Skull fractures Investigations Head injuries SBS: Parents reunited with children after mistake VFPMS experience Types of injuries No. of Patients Subdural Haemorrhage 23 (41%) 13 (56%) bilateral 10 (44%) unilateral Subdural Effusion 10 (17%) 7 (70%) bilateral 3 (30%) unilateral Skull fracture 29 (51%) 18 (62%) isolated skull fracture 11 (38%) associated with another intracranial injury Subgaleal haemorrhage 9 (16%) All associated with other injuries Extradural haemorrhage 4 (7%) All associated with other injuries 3 (75%) unilateral ,1 (25%) bilateral Australia/NZ experience Sydney:65 cases over 7 years (Ghahreman et al 2005) Subdural haemorrhage most common injury(81.5%) 55% evidence of extracranial skeletal findings (20%) clinical evidence MRI revealed additional findings in 49% Ghahreman A, Bhasin V, Chaseling R, Andrews B, Lang E. Non accidental head injuries in children:a Sydney experience. Journal of Neurosurgery. 2005;103(September):213-8. Nomenclature “Shaken Baby Syndrome” “Battered Child Syndrome” “Abusive Head Trauma” “Non Accidental Head Injury” Subdural Haematomas: Anatomy Subdural Anatomy The controversies The triad: retinal haemorrhages + subdural haemorrhages+encephalopathy Geddes: “unified hypothesis” pathogenesis of SDH +RH was hypoxia ischaemia not trauma Dr Squier : raised arterial and venous pressure, quoted mechanical studies Geddes J.F. et alDural haemorrhage in non-traumatic infant deaths:does it explain bleeding in “shaken baby syndrome”? Neuropathol Appl Neurobiol 2003,29:14-22 Squier W Shaken baby syndrome;the quest for evidence Dev Med Child Neurol Jan 2008;50:10-14 The controversies contd. UK Court of Appeal – R v Harris, Rock, Cherry and Faulder [2005] EWCA Crim 1980 2 convictions quashed Squier W,Adams L.B. The triad of retinal haemorrhage,subdural hae