Pediatric Head Injuries

Children keep growing and their brain is still developing. So, injuries sustained by their little brain may have lasting effects.


No age group is exempt from head injuries. However, the cause of head injury varies among age groups and from one region to another. For example, in India, fall from height is common. Whereas in the West, child abuse is the common cause of head injury in children.

Common Causes

Few common causes of head injury among children include:

  • Fall

    From balcony, cot, or while the child learns to walk or is engaged in play.

  • Road Traffic Accident

    Among children, road accidents are more common on the way to school and back.

  • Injury During Birth

    Injuries can happen to the baby’s head when instruments are used to pull th ebaby out of the birth canal or if the baby’s soft skull presses agains the mother’s pelvic bones, while pushing its way out.

  • Child Abuse

    Shaking a child vigorously results in injury to the nerves and blood vessels in the brain, sometime cause tiny bleeds in the brain.

Type of Head Injuries

Even through the injuries in children are the same as that in adults, children present with unique features. The clinicial picture and management are different too. Following are few types of injuries sustained by the pediatric age group:

  • Scalp Injury

    In infants, injury to the scalp is usually sustained during birth, as the child passes through the birth canal. In other age groups, scalp injury is very common during the child’s playtime, mainly due of falls.

  • Fracture

    Fractures are uncommon in children because children’s skull are softer than adults and can mold easily. But when the injury is too severe, two types of fractures may result. Linear or a straight line fracture and depressed fracture, where a small part of the skull gets distorted or deformed, as it tries to mold itself.

  • Hematomas

    A bleed in the brain is known as hematoma. This can occur when a vein or artery is damaged, as a result of head trauma. The bleed can occur above (extradural) or below (subdural) the dura mater (a touch sheath covering the brain), or within the brain (intra cerebral).

  • Contusion

    A bruise on the surface of the brain is known as contusion. When the head goes through a violent movement, the forces cause the brain to move within its enclosure and strike or squeeze itself against the outer covering protecting it. This bruises the brain. Children don’t show symptoms immediately after a contusion. So a careful observation for a delayed deorientation is required.

  • Diffused Brain Swelling

    This condition is 2-5 times more common in children than in adults as a child’s brain is so delicate. This usually happens when any head injury initiates fluid accumulation in the brain and hence brain swelling. Even a mild head injury might result in diffuse brain swelling. A CT scan should be performed to recognize the condition early, for immediate intervention.

  • Diffuse Axonal Injury

    Diffuse means ‘scattered’. Axon is the part of a brain cell that is involved in transferring information within the brain. During a fall or a traffic accident where the child is knocked down by the vehicle, brain shakes vigorously, causing damage to the axons. The injury is scattered across the brain, hence the term ‘diffuse axonal injury’. This often occurs together with a concussion.

Complications due to Pediatric Head Injuries

Disseminated Intravascular Coagulation (Disseminated: widespread, intra: inside, vascular: blood vessel, coagulation: Clotting of blood) is a common complication arising out of head injuries.

The brain tissue is a rich source of thromboplastin, a protein that helps in the clotting of blood. When the brain is injured there is an outpouring of thromboplastin from the brain into the blood. This causes a widespread clotting cascade throughout the body. Small vessels get blocked because of random clots obstructing the flow of blood. This compromises blood supply to various regions.

However in time, all the proteins that help with the clotting process is consumed and deficiency results. When there is deficiency, the opposite happens. There is random bleeding from different sites. Bleeding may be so profuse that it becomes difficult to control. If it is not treated early, this lead death of the child.

To prevent this, all children who sustained severe head injury must be monitored closely and their blood parameters should be measured regularly.


Common symptoms after a head injury are:

  • Vomiting
  • Nausea
  • Headache
  • Vision problems
  • Fits
  • Loss of consciousness
  • Irritability
  • Restlessness
  • Agitation
  • Low heart rate
  • Weakness of one or more parts of the body
  • Difficulty concentrating

Not all symptoms are seen in every child with a head injury. Depending on the type and severity of the condition, symptoms vary.

Some minor traumas don’t present with any symptom. Children return to their play immediately after the hit, but come back with complications later. So, apart from symptoms, further diagnostic investigations are required to evaluate the child and provide appropriate management.


Here are the standard tools used for diagnosing a head injury in a child and possibly its effects:

  • X-Ray

    This is an useful diagnostic tool that shows skull fractures clearly at a Glance. A swelling resulting from head injury can also be appreciated easily appreciated.

  • CT Scan

    To get a detailed view of the brain, a CT scan is required. Minor fractures missed by an X ray can be spotted by a CT scan. Bleeding or changes in brain structure can also be identified using this imaging modality.

  • MRI Imaging

    To get a clearer view of blood vessels and exact location of a bleed, an MRI image is required. Since brain is a soft tissue, minor changes in brain structure can also be easily picked up in an MRI.

Treatment for Pediatric Head Injuries

Treatment to Pediatric Head Injury depends on its type and severity. Minor concussions and contusions can be left untreated and injuries that don’t show up on imaging and don’t produce symptoms can be left without a treatment. As a child’s brain is growing, minor injuries heal on their own in the course of time.

Hematomas that are seen at birth also heal on their own in two weeks. However, large hematomas, fluid accumulation in the brain, brain swelling and expanding fractures need to be addressed immediately.

Medical Treatment

Most of the medical treatment for Pediatric Head Injuries are administered for moving the fluid accumulation from the brain. Nerve protecting medication and drugs that prevent seizures are also given.

Surgical Treatment

Surgical treatment for pediatric head injuries fall in to the following categories:

  • Evacuation of Hematoma: A small hole is drilled into the skull and the accumulated blood is removed.
  • Shunt Placement: When there is brain swelling because of fluid accumulation, a metallic tube is placed in the brain that sucks excess fluid from the brain and directs it to any other space in the body that can absorb the incoming fluid. This relieves the pressure inside the brain and prevents further damage.

Go here for more information on surgical treatment for the ailment.

Treatment Window

Recovery of the child with head injury depends on the child’s age at the time of injury, severity of the injury and its location. Early identification of the injury and initiation of appropriate treatment helps to save the child’s brain.

Plasmacytoma: Tumor of the Marrow of the Backbone

When abnormal plasma cells (white blood cells) seen in any bone in the body, it is called a plasmacytoma.

Introduction to Plasmacytoma

Plasma cells are a type of white blood cells. They produce large volume of antibodies, which weapons used by the body against invading parasites. Plasma cells are produced in the bone marrow. When the plasma cells become abnormal in the bone marrow, the condition is called plastocytoma.

By definition, a plastocytoma occurs in only one location in the body, usually in an axial skeletal bone (rib cage or backbone). In 2 to 4 years, it can be seen in multiple locations, including some soft tissue. Once this condition is seen in multiple locations, it is called multiple myeloma.

As a neuro-surgery unit, CNS is concerned only with plastocytoma of the spine. The part of the spine that supports the ribs are most often affected by this condition. Men older than 50 are the frequent victims.

Complication due to Plasmacytoma

Untreated plasmatycomas spread throughout the body, causing a condition called multiple myeloma. In this condition, all the blood cells formed inside the bone are destroyed, leading to increased risk of injections, bleeding and anemia.

Symptoms of Plasmacytoma

Here are the usual symptoms of plastocytoma. Based on the location and severity of the condition, the symptoms vary:

  • Bone and joint pain
  • Muscle pain
  • Muscle weakness
  • Paralysis
  • Gait problem

Diagnosis of Plasmacytoma

These are the tools used often to diagnose a plastocytoma:

  • Serum Protein Electrophoresis

    This blood test analyses the quantity of various antibodies in the blood. A person with plastocytoma produces large quantities of a particular type of white blood cell, which in turn produces large quantities of a particular antibody. Unusually large quantities of any one antibody in the blood indicates the possibility of plastocytoma.

  • X Ray

    Large areas of bone destruction can be observed at the site of a plastocytoma. In the image, plastocytoma looks somewhat like a soap bubble.

  • CT Image

    CT image has better resolution than an X-Ray image. Hence, it is used to assess the spread of the tumor.

  • MRI Image

    An MRI image can be used to visualize the involvement of nerves and blood vessels. An MRI is also used to determine that there are no other tumor sites within the rib/spine.

  • Bone Marrow Biopsy

    A tiny bit of bone marrow tissue is extracted and analyzed. This gives information about the exact nature of the tumor cells, probability of its spreading to other locations in the body, etc.

Treatment of Plasmacytoma

Here are usual treatments offered for a plasmacytoma:

Radiation Therapy

Plasmacytomas are very sensitive to radiation therapy. They get easily destroyed when exposed to radiation. So, radiation therapy is the treatment of choice here.

Surgical Treatment

Decompression and Stabilization of Spine: As the plasmacytoma tumor grows in size, it causes destruction of backbone and compression of nerves present in that area. Surgery is usually required to relieve the nerve compression and correct the spinal deformity.

Related links:

  • Decrompression of spine
  • Spine Stabilization

Medical Treatment

Medicines do not cure plasmacytoma. However, pain killers are prescribed to reduce the pain reported by the patients.

Treatment Window

Plasmacytoma starts with a single site. When it is diagnosed, an immediate treatment with radio therapy is recommended.

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