Acute Signs of Elevated Intracranial Pressure Caused by Hydrocephalus Occlusus Following an Intraventricular Hemorrhage after Falling from a Highchair

Introduction

In Germany a total of 581 patients per 100 000 inhabitants among the 0–16 year age-range suffer a traumatic brain injury (TBI). Of these approximately 90% can be categorized as slight and without dire consequences. The mortality rate of TBI is 0.5%. The risk rises proportionally with the severity of the injury. [Dunning J et al., Arch Dis Child 2004; 89: 653–659]. According to the current AWMF-guidelines for TBI among children, in case of a light TBI without disturbance of consciousness (Glasgow-Coma-Scale (GCS) 14–15) clinical in-patient surveillance for 12–48 h is recommended.

Due to the heightened radio-sensibility of a child’s head, the decision for or against computed tomographic examination should be weighed carefully. In contrast, patients with signs of disorientation (GCS<13), focal neurological abnormalities and open head wounds indicate a prompt cranial computed tomography (CCT) in order to rule out an intraventricular hemorrhage. If the mechanism of the accident is severe and brings persistent headaches, change in behaviour and recurrent vomiting then a CCT should also be carried out. A fall from a height of approximately 1m on the occipital head has a high incidence of additional cervical spinal or craniovertebral junction trauma. This should lead to an early investigation of that region as well, e. g., in a patient with neck pain. All young children are predisposed for additional cervical trauma due to a relatively large head compared to the body length. Mostly these lesions are soft tissue lesions and better visualized on magnetic resonance imaging scan (MRI).

Skull and cervical spine x-rays have a low sensitivity and are therefore not recommended in any case. A sonography of the skull, an electroencephalogram or a cranial MRI might be used additionally. Clinical symptoms of an intraventricular hemorrhage resulting from a TBI usually appear within the first 12 h. This necessitates continuous clinical supervision.