PEARLS AND PERILS

1. Injury at a younger age (younger than 4-6 years) typically results in poorer outcomes. This is per­haps due to increased vulnerability of the young child's brain to injury and the injury's impact on development.

2. Following a concussion, the injured brain cells are vulnerable to repeat injuries, which can cause extensive neuronal loss. For this reason, the brain should be rested following the concussion until all symptoms have resolved.

3. The long-term outcomes in motor, cognitive, and behavioral function may be better in focal injuries versus diffuse injuries, given the isolated nature of the brain damage.

4. Context-sensitive rehabilitation, with integration across many domains of functioning, and providers using the team approach should be practiced.

5. Care needs to be taken to distinguish cerebral atro­phy (hydrocephalus ex vacuo) from posttraumatic hydrocephalus.

6. In children, seizures early after injury do not corre­late with late seizures.

7. Long-term anticonvulsant prophylaxis has not been shown to decrease the development of late seizures.

8. Children often perform better in an evaluation set­ting than in their daily life.

9. It is important to be able to distinguish between diabetes insipidus, syndrome of inappropriate anti­diuretic hormone, and cerebral salt wasting.

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