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> Do we really want to find non-operable blood in the brain or are we creating more morbidity and multiple cat scannings when we find it?
--> A good question.
Most of my experience is in adults, where very often, simply knowing that there is a bleed there, but no operation required, may well help with REDUCING multiple doctor visits and allow the patient to "settle" into symptom control mode.
It also affects driving licensing in the UK.
In a 1YO child, I'm not sure. Especially if asymptomatic.
> Does it prevent morbidity as opposed to following clinically for neurological changes?
--> Again, depends on the case. In adults it often can make a difference, e.g. if they are anticoagulated, or come in with chest pain a few days later, requiring thrombolysis, or if it affects their work, etc...
In a 1YO, I suspect it would not commonly be a factor...
BTW, as you asked and as I am in the ED tonight, I've had them dig up the paperwork and I now recall the case better (it was 11 months ago). The bleed was an intracerebral haematoma with ?SAH. Surgery was NOT undertaken, after some debate. The patient has been followed up since and has been retained for follow-up because of abnormalities of gait, which have developed since. Possibly related. I'm not sure, as I only have minimal records.
Perhaps - I'm not sure - the knowledge of the mechanism behind the gait issues may reduce the need for further, perhaps uncomfortable investigations.
Still, this was one case I did recall because of the unusual mechanism. A few others did end up with surgery... And, of course, we do not know that it will be a non-operable bleed we're going to find when we order the CT... ;-)
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