Age-dependent diversity of pediatric head injury was overviewed and significance of early implementation of rehabilitation in head-injured children was emphasized. Survivors from severe traumatic brain injury (TBI) often sustains chronic physical and cognitive dysfunction. It is important for physicians and therapists to provide them with early rehabilitation treatment in a cordinated way. These children often require a long-term support from medical as well as educational specialists after finishing the hospital phase of rehabilitation.
Trauma victims are directly transferred to a level I trauma center bypassing local hospitals. First, airways and cervical stability are secured. Intracranial hematoma should be promptly evacuated. Endotracheal intubation and mechanical ventilation are initiated for children with a Glasgow Coma Score of 10 or less, anisocoria, apnea, and/or hypercarbia. Isotonic crystalloid is used for intravenous fluid maintenance. The goal of intracranial pressure (ICP) management is to maintain the ICP at less than 15mmHg and to maintain minimum cerebral perfusion pressure at 45-55mmHg. External ventricular drainage provides direct control of the ICP by allowing intermittent drainage of the CSF (5-10m//hour). Mannitol is effective but hyperventilation is not recommended.
Encephalitis/encephalopathy is a neurological syndrome characterized by acute onset, symptoms of intracranial hypertention accompanying severe sequels or death. Encephalitis is caused by microbial infection of central nervous system, such as neurotrophic or conventional viruses. Infectious encephalopathy shows similar clinical symptoms to acute encephalitis, without any evidence of inflammation and microbial infection in brain tissues. The national epidemiological surveillance of the diseases is carried out to study the frequency and prognosis of patients with both diseases. The principal treatment is quite different in the both, in the former the eradication of microbial from the brain and in the latter the reduction of pressure of brain edema. Furthermore, the improvement of the brain with severe destruction requires such new step to reduce the activities of enzymes or cytokines to destroy brain tissues, as a mild hypothermia to lower body and brain temperature to 33-34°.