From the Guidelines
The best management for an 11-year-old child presenting with seizures two weeks after head trauma is option C: Follow up with serial Brain CT, as it allows for monitoring of any evolving intracranial pathology that might be causing the seizures 1. The child should undergo an immediate CT scan to establish a baseline and rule out conditions requiring urgent intervention such as delayed hemorrhage, cerebral edema, or evolving contusions.
Key Considerations
- Serial imaging (typically at 24-72 hours initially, then as clinically indicated) helps track any changes that might require surgical intervention.
- The use of antiepileptic drugs for primary prevention to reduce the incidence of post-traumatic seizures is not recommended, according to a study published in Anaesthesia in 2018 1.
- However, in cases where antiepileptic drugs are considered necessary, levetiracetam should be preferred over phenytoin due to its higher degree of tolerance.
- Conservative management alone (option A) is insufficient given the presence of seizures, which indicate significant brain involvement.
- A burr hole (option B) would be too invasive without clear evidence of a surgical lesion.
- Mannitol infusion (option D) is only appropriate for acute management of increased intracranial pressure, not as primary management for post-traumatic seizures without confirmed elevated ICP.
Imaging Recommendations
- CT head without IV contrast or MRI head without IV contrast is usually appropriate for the initial imaging of children with post-traumatic seizures, as stated in the 2021 study published in the Journal of the American College of Radiology 1.
- These procedures are equivalent alternatives, and only one procedure will be ordered to provide the clinical information to effectively manage the patient’s care.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Management of Traumatic Brain Injury
The management of traumatic brain injury (TBI) depends on the severity of the injury and the presence of any complications. In the case of an 11-year-old child who has had a head trauma 2 weeks ago and is now experiencing fits, the best management approach would be:
- Follow-up with serial Brain CT to monitor for any changes in the injury and to assess for any potential complications such as intracranial hemorrhage or raised intracranial pressure 2, 3
- The use of computed tomography (CT) is recommended for the initial assessment of acute head injury because it is fast, widely available, and highly accurate in the detection of skull fractures and acute intracranial hemorrhage 4
- Magnetic resonance imaging (MRI) may also be useful in the evaluation of subacute or chronic traumatic brain injury, especially in cases where the neurological findings are unexplained by CT 4, 5
Treatment Options
The treatment options for TBI include:
- Conservative management, which may involve close monitoring and supportive care 2
- Surgical intervention, which may be necessary in cases where there is a significant intracranial hemorrhage or raised intracranial pressure 3
- The use of mannitol infusion to reduce intracranial pressure, although this is not always effective and may have potential side effects 3
- Burr hole surgery, which may be necessary in cases where there is a significant intracranial hemorrhage or raised intracranial pressure 3
Imaging Modalities
The imaging modalities used in the management of TBI include:
- Computed tomography (CT), which is the modality of choice for the initial assessment of acute head injury 4, 2
- Magnetic resonance imaging (MRI), which may be useful in the evaluation of subacute or chronic traumatic brain injury 4, 5
- Diffusion tensor imaging, which may be useful in the assessment of traumatic axonal injury 5