Traumatic brain injury in Indian children.

INTRODUCTION: Traumatic brain injury (TBI) in children and adolescents is a community-based medical and educational challenge world-over due to increasing urbanization and motorization. In India, children between 1 to 15 years constitute significant proportion of the total population, who are vulnerable for TBI. In developed countries, pediatric trauma mortality still represents more than half of all childhood fatalities, which is 18 times more common than brain tumors. In this study, we attempted to analyze epidemiological factors, management, and outcome of TBI in children at a tertiary care center in Pune, Maharashtra. AIM AND OBJECTIVES: To study the clinical spectrum of pediatric traumatic brain injury cases received at a Tertiary Care Hospital. MATERIALS AND METHODS: This prospective study (August 2015-July 2017), conducted at our institution, includes all children < 16 years with TBI reporting to the neurosurgical emergency department. All the case records were reviewed and the pertinent data (clinical history, age, sex, mode of injury, computed tomography (CT) scan findings, interventions, morbidity, and mortality) analyzed. Any residual neurological deficits at the time discharge were assessed as the outcome of TBI. RESULTS: A total 76 pediatric cases of TBI were admitted during the period of August 2015-July 2017, with 51 males (67%) and 25 females (33%) with male to female ratio 2:1. Mean age of incidence in our study is 5.5 years. Out of 76 children with TBI, 60.5% were of mild, 14.5% moderate, and 25% severe TBI. Overall, RTA (40.8%) is the most common mode of injury followed by fall from height (30.2%) and slippage in and around home (26.4%). Clinical evaluation revealed, loss of consciousness(LOC) in 36 (47.3%) patients, vomiting in 42 (55%) patients, headache in 10 (13%) patients, ENT bleeding in 18 (23.6%), and seizure in 16 (21%) patients, no external injuries in 25 (33%) patients, normal sensorium was found in 41 (54%) patients, 18 (23.6%) children were drowsy at presentation, and 17 (22.3%) children were unconscious. CT scan findings revealed no gross abnormality in (26%), extradural heamorrhage (EDH) (18.4%), subdural hemorrhage (SDH) (14.4%), subarachnoid hemorrhage (21%), fracture skull (55.26%), cerebral oedema, and contusion (48.68%) as the radiological injury patterns. Out of 76 children, 42 (55%) children are managed with only observation, 26 (34%) children required only medical pharmacological treatment, and 8 (10.5%) children required surgical intervention, 24, (31.6%) children required mechanical ventilation. Overall mortality is 5.26%. Thus among the survivors (n = 72), 57 (79%) went home with no residual deficit, 3 (4%) had headache, 4 (5.5%) had hemiparesis, 2 (2.7%) had monoparesis, 1 (1.4%) had hypertonia, 3 (4%) had seizures, 2 (2.7%) had hydrocephalus, 2 (2.7%) had facial palsy, 2 (2.7%) had vision impairment, and 2 (2.7%) had speech impairment. In our study, we found that there is a significant association between residual deficits and severity of injury (p = 0.3), there is no significant association between mode of injury and outcome (p = 0.7). Mean duration of stay in hospital was 6.9 days but 60% of patients had stay of less than 5 days. CONCLUSION: Most of these injuries are preventable in infancy and childhood by ensuring proper vigilance, tender care by the parents and the caretakers. Safe driving techniques have to be followed by parents while traveling with children in their motor vehicles. Need to focus on grading the severity of TBI rather than on factors like age, mode of injury, and presence or absence of external injuries.

Posttraumatic Pseudoaneurysm of Extracranial Internal Carotid Artery Presenting as Massive Oropharyngeal Bleed with Shock and Hemiparesis in a 12-year-old Boy: A Case Report.

Aneurysm in the extracranial segment of the internal carotid artery is extremely rare in children. Traumatic aneurysms of the internal carotid artery are generally "false aneurysms" (pseudoaneurysms) with at least part of the aneurysm wall composed only of the adventitial layer, or even just by the hematoma. There are few reports in the world medical literature about its etiology, presenting features, and catastrophic consequences. The natural history of the disease has not been well-defined yet. However, the potential risk of embolism originating from the aneurysm or even its rupture indicates a need for early diagnosis and intervention. We present a 12-year-old previously healthy child with recurrent oropharyngeal hemorrhage leading to massive hematemesis and hypovolemic shock due to right-sided internal carotid artery pseudoaneurysm with hemorrhage and right middle cerebral artery territory infarct. The child required urgent endovascular stenting with decompressive craniectomy for life-threatening intracranial bleeding with herniation with near-complete recovery.

A Case Report of Pleuropulmonary Blastoma Presenting as Tension Pneumothorax.

Pleuropulmonary blastoma (PPB) is a very rare, highly aggressive, and malignant tumor that originates from either lungs or pleura. It occurs mainly in children aged <5 or 6 years. It has poor prognosis with three different subtypes: cystic (type I), combined cystic and solid (type II), and solid (type III). PPB is treated with aggressive multimodal therapies including surgery and chemotherapy. We present a case of PPB in a 3-year-old girl who presented with tension pneumothorax.