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Pp. 477–496. 2. Nehls DG, Mendelow AD, Graham DI, Teasdale GM (1990). Experimental intracerebral haemorrhage: early removal of spontaneous mass lesion improves late outcome. Neurosurgery 27, 674. 3 Paediatric Neurosurgical Emergencies: A Problem-Based Approach Keith YC Goh Introduction The doctor who practises in a large general hospital does not frequently encounter neurosurgical emergencies in children. In most countries, these cases are usually diverted to the nearest children’s hospital, where trained paediatric doctors are available to deal with the special problems which this patient group presents.
Ping-pong” fractures are depressed fractures which occur because of the relatively thin cranial vault. The surgeon can easily elevate them by making a small adjacent burr-hole, then levering the depressed segment of bone upwards. This springs back into place in a similar manner to a ping-pong ball. In this age group, “growing” Fig. 1 CT scan of the brain showing a left acute subdural haematoma. 44 KYC Goh Fig. 2 CT scan showing a chronic subdural haematoma with accompanying cerebral atrophy. fractures are sometimes also encountered.
2 Left thalamic ICH (deep). Fig. 3 Left cerebellar ICH (greater than 3 cm diameter). Intra-cerebral Haemorrhage in Adults 31 herniation (coning). On the cellular level experimental studies have shown decreased local cerebral blood flow, hyperaemia, dysautoregulation, and blood-brain barrier disruption in the brain surrounding haematomas. These events are thought to initiate a cascade of biochemical processes that precipitate cellular metabolic disruption and eventual cell death. The biochemical cascades are thought to be similar to what happens in cerebral ischaemia.