As patient continued to have persistent headache I decided to do the CT scan. MRI was an option but clinical exam did not warrant for an emergent MRI. Radiation risk and benefits were discussed with family and CT head was orderedThere was an immediate call from radiologist and the report was-----Significant mass effect with midline shift, subfalcine herniation towards the right relating to a isodense subdural hematoma measuring about 15 mm around the left frontal lobe. Also 3 cm isodense collection in the left temporal fossa concerning for epidural hemorrhagic component or parenchymal hemorrhagic contusion. Neurosurgery and trauma consults were given. Remained stable in the ER. Patient was taken to the OR. Patient got extubated next day. As per PICU team doing well and no focal deficits but has some irritability.
Thank youLakshmi Vemuru M.D, FAAPToledo Children's Hospital, OH
> Date: Sat, 3 Nov 2012 23:10:33 -0500
> From: [log in to unmask]
> Subject: Re: Teenager with two days of headache
> To: [log in to unmask]
> Thank you all for the responses. Answers to some of the questions that were asked:
> is a healthy teenager, no family history of migraines, no recent
> travel or tick bite, no rash or joint swelling, No neck pain or signs
> of meningismus. No visual complaints except for photo sensitivity,
> Normal fundus No imaging study was done since the time of the head injury . No history of weight loss or fatigue
> > Date: Sat, 3 Nov 2012 16:25:54 -0400
> > From: [log in to unmask]
> > Subject: Teenager with two days of headache
> > To: [log in to unmask]
> > A 15 year old male presented with headache for 2 days with associated photophobia, nausea but no vomitings. Past
> > history of head to head collision while playing football 6 weeks ago.
> > no LOC, no dizziness but had mild headache. Assessed by trainer
> > at that time and cleared. Went to PCP two days later diagnosed with possible concussion and
> > cleared
> > for sports after 2 weeks. Interval history of occasional mild
> > headaches otherwise no complaints and continued to play football. Seen
> > by PCP day prior to our ED visit because of headache and photophobia.
> > Diagnosed with migranes and prescribed NSAIDs. Presented to our ER
> > because of persistent headache.
> > Alert oriented X3 pupils equal
> > reactive. Vitals afebrile, RR16, BP 132/68, HR 98 oxygen sat 98%.
> > Physical exam no signs of external injuries, clear breath sounds,
> > normal heart sounds. No orthostatic changes. No focal neurological
> > signs but complains of dull headache and photosensitivity. Mild nausea
> > no
> > vomiting episodes. IV fluids, toradol, and zofran given with
> > minimal improvement. Continued to watch TV and interacting with family
> > but requested to keep lights off. But no change in vital signs and
> > remained stable with no cardiorespiratory distress
> > Questions to the group:
> > 1)With this history and physical exam how will you proceed further in this patient's management?
> > 2) At this time would you do CT scan head or not ?
> > 3) Any votes for MRI?
> > 4) Admission for pain management?
> > 5) Consult Neurologist and wait to hear from him?
> > Thanks
> > Lakshmi Vemuru M.D; FAAP
> > Toledo Children's Hospital, OH
> > For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> > The URL for the PED-EM-L Web Page is:
> > http://listserv.brown.edu/ped-em-l.html
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is: