Pathophysiology and Treatment of Severe Traumatic Brain Injuries in Children

The clinical characteristics of posttraumatic epilepsy following moderate-to-severe traumatic brain injury in children

“…Posttraumatic epilepsy (PTE) has a negative impact on the longterm quality of life in children following TBI [5][6][7][8][9]. Several studies in children [10][11][12], as well as in adults [13][14][15], have shown that the risk of PTE increases with the severity of TBI.…”

Traumatic Brain Injury in Children

“…Under such pathophysiologic conditions, CBF continues to decline to reach ischemic level thus exacerbating the impact of secondary injury [19]. CBF restoration may also cause reperfusion injury mediated by oxidative stress, leukocyte infiltration, and blood brain barrier dysfunction [20,21].…”

“…Deterioration of CBF deprives the cells of their metabolic needs and forcing them to switch into anaerobic metabolism. Less energy and more lactate production in anaerobic metabolism give rise to failure in cellular functioning and generate an acidic milieu [20]. Moreover, the glial-neuronal uncoupling further enhances extracellular lactate production independent of ischemia, resulting in lactate storm in severe cases [22].…”

“…Massive sodium influx precipitates the cascades in secondary injury through neuron depolarization. Depolarized neurons release excitatory neurotransmitters, including glutamate and aspartate, which leads to intracellular calcium increase and enzymes and free radicals activation [20,22,23]. Neuronal cells degradation triggers neuroimmune responses and instigates BBB dysfunction, both of which add up to the cerebral edema progression [23,24].…”

“…According to the Monro-Kellie doctrine, the brain responds to the edema by displacing CSF and venous blood away. Failure of this compensation mechanism ultimately results in brain compression and death [20,23].…”