Wed, 26 Feb 2003

Identifying your children's head injuries

Dear Dr. Donya,

My 14-month-old daughter sustained a linear skull fracture in a fall. It was the back of her head. In your article you said that most people don't have any long term affects from this but I was wondering what are some of the possible long-term affects from this injury?

I would like to know everything that could possibly occur later in life. I have heard that tumors and cysts on the head are possible side affects. Is this true?

-- Kasey

Dear Kasey,

There is research that shows infants can fracture their skulls from two- to three-feet falls, but intracranial injuries from short falls in infants are very rare.

The long-term side effects after linear skull fracture are Lepto-meningeal cysts. This is a rare complication that may develop when there is a linear fracture of the skull with separation of the edges of the fracture and laceration of the tough membranous covering of the brain called the dura mater. The arachnoid membranes (very thin, transparent and "spidery" appearing from the myriad tiny blood vessels) can be trapped between the edges of the fracture. When this happens, the natural pulsation of the brain caused by the throbbing of the arteries causes erosion of the bony skull.

This complication can occur in adults, but it is most often seen following fracture of the skull in infants and young children. These cysts usually occur in infants during the years of rapid brain growth and are rare after three years of age. Leptomeningeal cysts are usually delayed complications of skull fractures, although they occasionally occur within weeks of trauma.

Since the infant skull is highly malleable, the margins of pediatric skull fractures are often inwardly displaced at the time of trauma. Depressed, or transiently depressed, fractures can easily lacerate the underlying dura and severely contuse the adjacent brain.

The condition is detected when the parents note a cystic (soft and squishy, reminiscent of a water-filled balloon) mass on the head of their infant and the correct diagnosis will become apparent on a simple skull x-ray.

Potentially, untreated leptomeningeal cysts could lead to seizures, mental retardation, and increased intracranial pressure (hydrocephalus), so surgical repair is imperative. Treatment involves surgical removal of the cyst and repair of the tear in the dura.

-- Dr. Donya

Dear Dr. Donya,

I just read your article on the web concerning head injuries. My 10-month-old daughter just fell back in a chair and hit her head on a brick floor in a corner (she may have hit her head on the walls as well). She shows no signs of a head injury, but I have heard of those cases where they show no signs and then wake up dead in the morning.

How can she fall like that and not be hurt? How can I make sure she is okay? We are taking her to her doctor, but I am afraid he will just feel her head and say she is okay? I want to be positive she is okay.

-- Reader

Dear Reader,

Head injuries can range from relatively minor damage to the scalp and face such as lacerations, abrasions and bruising to more serious consequences involving damage to the brain.

While traumatic brain injury occurs much less frequently, it is important to know how it is identified and what to do for the person.

It is clear that extra-axial blood collections and skull fractures can occur from minor falls, although this is rare. Most studies suggest that lethal injury from short falls (less than 4 feet) probably does not occur. I am quite sure that she will be fine.

-- Dr. Donya