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TRAUMA CRANEOENCEFÁLICO
MBE
dermatologia en linea
dermatologos en linea
 
trauma penetrante de cráneo particularmente por proyectil de arma de fuego, PG de 3 a 5 que
se prolonga después de la admisión (20-60%), la presencia de pupilas midriáticas fijas
(compresión del tallo), coagulopatía, disfunción de múltiples órganos, bradicardia,
requerimientos de vasopresores. PPC baja el primer día en UCIP (Recomendación C31,32).
Aún no se han validado los modelos de predicción de mortalidad propuestos en niños por varios
autores que emplean estos factores de riesgo. La lesión axonal difusa causa inconciencia
prolongada, asociándose con alta mortalidad y los sobrevivientes persisten en estado
vegetativo. El pronóstico funcional de los niños en términos generales es mejor que el de los
adultos. En escolares y adolescentes puede ocurrir mejoría durante el primer año después del
evento. El déficit intelectual se relaciona en forma directamente proporcional con la duración del
coma cuando este excede tres semanas y con la duración de la amnesia postrauma si es
mayor de 1 día. Problemas cognitivos y comportamentales se asocian con un PG de 3-4; edad
menor de 3 años (más inmadurez del SNC); bajo flujo sanguíneo cerebral, hipoxemia e
hipotensión. En un estudio en 27 niños con TCE severo la diferencia arteriovenosa del
contenido de lactato mayor de -0.37mmol/L en dos o más mediciones y la svyO2 = 55% en dos
o más ocasiones se asociaron con pobre resultado neurológico a los 3 meses del evento pero
con intervalos de confianza del 95% muy amplios. Estos parámetros no han sido validados aún
como predictores en otros niños con TCE severo (idealmente en forma prospectiva) y se
desconoce su verdadera utilidad (Recomendación C33). Es evidente que la prevención es
fundamental, el tratamiento debe disminuir la lesión secundaria, la rehabilitación debe ser
oportuna y el seguimiento adecuado.
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