2. A male child fell 19 feet on to his head. He was concussed, and, on admission, presented a hæmatoma over the right fronto-parietal region, and subconjunctival hæmorrhage in the left orbit. Four days later he was apathetic and there was some paresis of the left arm and leg. As the hæmatoma became softer, pulsation was noticed over a small area, and, in this situation, the swelling increased in size on straining. A fracture was detected later, one-third of an inch in diameter, and extending across the left frontal bone to the right temporal region. Pressure was applied, the tumour steadily decreased in size, and eventually the gap was completely closed.
Synopsis of 38 cases of traumatic cephalocele.
- Sex. Males, 16. Females, 13. Sex not stated, 9.
- Age at time of accident.
- 2 cases at birth.
- 9 in the first 6 months.
- 9 in the second 6 months.
- 14 between 1 and 2 years of age.
- 1 between 3 and 10.
- 1 between 10 and 15.
- 1 between 15 and 20.
- 1 between 20 and 30.
- Region affected.
- Right parietal, 17 cases.
- Left parietal, 4 cases.
- Other bones, right and left, 8 cases.
- Parietal with others, 9 cases.
- Parietal bone involved in 30 out of 38 cases.
- Right side involved in 27 out of 38 cases.
- Date of appearance of tumour.
- 7 cases in the first week.
- 11 cases in the second week.
- 4 cases in the third week.
- 4 cases between 2 and 18 months.
- In the remainder, date uncertain.
Fractures of the skull resulting from injuries received at or shortly after birth.
In the consideration of injuries to the skull and brain in babies the following points should be noted:—
1. The bones of the skull are elastic and pliable, and consequently a blow may lead to a ‘bending-in’, either temporary or permanent. Slight depressions may exist without any associated fracture, but all major depressions are accompanied by a fracture of the bone, especially evident on examination of the internal table.
2. The fibrous tissue intervening between the component parts of the vault tends to cause a limitation of the fracture to the particular bone affected. Downward extension to the base is of infrequent occurrence, but, when that region is involved, the fracture usually follows the transbasic lines described in the section dealing with fracture of the base of the skull ([p. 82]).
3. The dura is said to be more adherent to the inner table of the skull than in adults. The relative infrequency in the young of extra-dural hæmorrhage has been ascribed to this peculiarity. It would appear, however, more probable that the rarity of such hæmorrhages results from the bending-in, without splintering, of the bone.
4. The brain of the infant is equally—if not more—liable to bruising and laceration, but the results are far less definite than in adults. There can be no question that extensive cerebral injury may exist in the child without leading to the development of any definite localizing symptoms.