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Potential Vulnerabilities - Mental Conditions - Post Traumatic Stress Disorder (PTSD)

Dr. William David Goldie, M.D.

Dr. Goldie is Certified by the American Boards of: Pediatrics, 1980 (Fellow), Psychiatry and Neurology with Special Competence in Child Neurology (1983), and Clinical Neuropsysiology, 1980. He is currently affiliated with nine hospitals including Children's Hospital of Los Angeles, LAC/USC Medical Centre, and St. Johns Regional Medical Center.


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Closed Head Injury in Infants and Young Children

Mechanisms and Long-term Complications
The Mechanisms:

The brain of a child can be considered as having the consistency similar to oatmeal in a bowl. Shaking or striking this bowl sets up compression waves that spread through the brain tissue, then bounce back and spread again. The child's brain has at least three layers of densities:

1) the firm and rigid brainstem, thalamus, and basal ganglia

2) the loose and fluid white matter

3) a firm layer of cortical gray matter

These three layers respond to compression waves in different manners. They shift and shake at different rates. The brainstem structures will twist and torque, while the white matter will slosh and ripple like jello, while the layer of gray matter will slip and slide and slam into the boney structures of the skull. Fiber tracts coursing between these different structures will rip, stretch, and tear with shearing forces.

Vascular structures will also rip, stretch, and tear producing bleeding at different levels. In tight spaces, this bleeding may remain microscopic, while m loose spaces it will expand into large clots. Anterior portions of the frontal and temporal lobes and posterior regions of the occipital lobes may develop contusion injuries from slamming into the boney skull.

Stretch injuries of the brain structures may repair fully. Tear injuries are more permanent. Vascular damage with clotting can lead to ischemic damage if a region of the brain is deprived of blood flow.

Large blood clots can produce extreme pressure effects. Damaged brain tissue will take on excess water, which will produce pressure effects. Blood flow and oxygen delivery to brain tissue depends on perfusion pressure which is measured as mean arterial pressure minus the intracranial pressure. If the blood pressure IS too low, and the intracranial pressure is too high, then brain perfusion pressure will drop to critical levels. Portions of the brain tissue may not get sufficient flow of blood nutrients and oxygen, especially in the watershed regions. Multifocal and regional brain infarcts will result.

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