LISTSERV mailing list manager LISTSERV 16.5

Help for PED-EM-L Archives


PED-EM-L Archives

PED-EM-L Archives


PED-EM-L@LISTSERV.BROWN.EDU


View:

Message:

[

First

|

Previous

|

Next

|

Last

]

By Topic:

[

First

|

Previous

|

Next

|

Last

]

By Author:

[

First

|

Previous

|

Next

|

Last

]

Font:

Proportional Font

LISTSERV Archives

LISTSERV Archives

PED-EM-L Home

PED-EM-L Home

PED-EM-L  January 2014

PED-EM-L January 2014

Subject:

Re: Minor head trauma and absence status?

From:

Michael Falk <[log in to unmask]>

Reply-To:

Michael Falk <[log in to unmask]>

Date:

Fri, 10 Jan 2014 12:14:01 -0500

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (114 lines)

Just in the process of writing review article on Concussion and this would
strike me as a TBI/Concussion.  CT scans are useless in evaluating these
sorts of injuries and MRI's are often the same.  It's based on extensive
neurological evaluation and the persistence of symptoms despite a
"negative" evaluation (i.e. CT scan etc).

Interestingly, the "force" associated with the actual blow is often not
perceived to be that "severe" but you will often find that it involves a
sudden back-to-front movement with a rotational aspect.  Part of the reason
that there has been serious push back by many to the concussion and CTE
research is that many of the injuries that are associated with these issues
have historically been perceived as not significant and that all the person
needs to do is shake it off (being "stunned" after "heading" a soccer ball!)

Final note: one of my favorite teaching points for the residents is "always
consider the uncommon presentation of a common illness  before the common
presentation of an uncommon illness".

Just my thoughts...hope it's helpful.

Mike Falk
New York, NY


On Thu, Jan 9, 2014 at 7:09 PM, Brown, Julie C. <
[log in to unmask]> wrote:

> I had a patient recently who had minor head trauma that I suspect may have
> been in absence status.  I wasn't able to find any similar reports in the
> literature.  I'm curious if anyone has seen this before.
>
> Here is the case:
> A young teen was running around in a skateboard park, playing tag (in
> sneakers, not riding a skateboard).  She fell back onto her occiput,
> possibly on a ramp, so with a little more force than with a typical fall
> from standing on a level surface.  She didn't pass out.  She didn't vomit.
>  Eventually, she was able to describe the event and what happened
> afterwards, including seeing the school nurse and getting picked up by her
> parents.
>
> On return home, she complained of occipital headache 4/10, nausea,
> dizziness and blurry vision and some varying decreased sensation in her
> right then her left hand.  For these reasons, she was brought to the ED 40
> mins after the event.  On evaluation, she was wretching and ultimately
> started vomiting.  Most of her exam was normal.  Her neuro exam was
> described as follows: Alert, moves all extremities, CN II-XII intact,
> Patient unable to consistently follow directions. When attempting to do
> finger-to-nose testing, patient grabs onto my finger instead of touching
> her nose. Also when testing for pronator drift she touches her wrist and
> palms together and does not hold her arms out straight. When asked if her
> sensation is intact bilaterally, she responds "I'm fine.".
>
> A head CT was obtained which was normal.  A drugs of abuse urine tox
> screen was negative. The patient was signed out to me with a plan to
> observe for a while and see if she improved, and if not, admit.  During the
> next hour or so, she remained confused, and started to have an unsual,
> rapid, shallow breathing pattern, while awake and talking
> (incomprehensibly) to me.  Repeatedly, when she fell asleep, she
> desaturated, initially to the 80's, then to the 60's, with a good tracing.
>  She was never cyanotic, but her nurse always quickly intervened by waking
> her up.  She was confused and had trouble expressing herself, saying things
> like 'I need to get this before me off my back' when trying to say she
> didn't like her cervical collar and wanted it off.  She could not follow
> commands.  For all these reasons, I consulted our PICU service, thinking
> her respiratory status was not sufficiently stable for the floor.  Half an
> hour later, the PICU attending and I walked into her room together, at
> which time she sat up, was conversant and coherent, described the events of
> the day in detail, denied significant headache, and could follow commands
> and do calculations.  Her breathing pattern was now normal.
>
> I was baffled at the time, as were her parents.  I let her fall asleep
> again, and when she didn't desaturate further, I admitted her to the ward
> service.  A while afterwards, I went home to sleep.  When I awoke, my very
> first thought on regaining consciousness was "she was in absence status."
>  This seems to make sense to me as it could explain her inability to follow
> commands, her respiratory changes, and her almost instantaneous recovery.
>  I called the inpatient team and suggested a Neurology consult, but the
> Neurologists didn't seem sold (and got a somewhat different version of
> events than what I witnessed), and didn't get an EEG.
>
> What do you all think?  Was my sleeping brain correct?  Or were these just
> post-concussive symptoms?  Have you ever seen a similar patient with
> absence status following minor head trauma?
>
> Julie
>
>
> ***************************************
> Julie Brown, MD, MPH
> Associate Professor, University of Washington
> Attending Physician, Pediatric Emergency Medicine,
> Seattle Children's Hospital
>
>
>
>
>
> CONFIDENTIALITY NOTICE: This e-mail message, including any attachments, is
> for the sole use of the intended recipient(s) and may contain confidential
> and privileged information protected by law. Any unauthorized review, use,
> disclosure or distribution is prohibited. If you are not the intended
> recipient, please contact the sender by reply e-mail and destroy all copies
> of the original message.
>
> 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:
                 http://listserv.brown.edu/ped-em-l.html

Top of Message | Previous Page | Permalink

Advanced Options


Options

Log In

Log In

Get Password

Get Password


Search Archives

Search Archives


Subscribe or Unsubscribe

Subscribe or Unsubscribe


Archives

August 2019
July 2019
June 2019
May 2019
April 2019
March 2019
February 2019
January 2019
December 2018
November 2018
October 2018
September 2018
August 2018
July 2018
June 2018
May 2018
April 2018
March 2018
February 2018
January 2018
December 2017
November 2017
October 2017
September 2017
August 2017
July 2017
June 2017
May 2017
April 2017
March 2017
February 2017
January 2017
December 2016
November 2016
October 2016
September 2016
August 2016
July 2016
June 2016
May 2016
April 2016
March 2016
February 2016
January 2016
December 2015
November 2015
October 2015
September 2015
August 2015
July 2015
June 2015
May 2015
April 2015
March 2015
February 2015
January 2015
December 2014
November 2014
October 2014
September 2014
August 2014
July 2014
June 2014
May 2014
April 2014
March 2014
February 2014
January 2014
December 2013
November 2013
October 2013
September 2013
August 2013
July 2013
June 2013
May 2013
April 2013
March 2013
February 2013
January 2013
December 2012
November 2012
October 2012
September 2012
August 2012
July 2012
June 2012
May 2012
April 2012
March 2012
February 2012
January 2012
December 2011
November 2011
October 2011
September 2011
August 2011
July 2011
June 2011
May 2011
April 2011
March 2011
February 2011
January 2011
December 2010
November 2010
October 2010
September 2010
August 2010
July 2010
June 2010
May 2010
April 2010
March 2010
February 2010
January 2010
December 2009
November 2009
October 2009
September 2009
August 2009
July 2009
June 2009
May 2009
April 2009
March 2009
February 2009
January 2009
December 2008
November 2008
October 2008
September 2008
August 2008
July 2008
June 2008
May 2008
April 2008
March 2008
February 2008
January 2008
December 2007
November 2007
October 2007
September 2007
August 2007
July 2007
June 2007
May 2007
April 2007
March 2007
February 2007
January 2007
December 2006
November 2006
October 2006
September 2006
August 2006
July 2006
June 2006
May 2006
April 2006
March 2006
February 2006
January 2006
December 2005
November 2005
October 2005
September 2005
August 2005
July 2005
June 2005
May 2005
April 2005
March 2005
February 2005
January 2005
December 2004
November 2004
October 2004
September 2004
August 2004
July 2004
June 2004
May 2004
April 2004
March 2004
February 2004
January 2004
December 2003
November 2003
October 2003
September 2003
August 2003
July 2003
June 2003
May 2003
April 2003
March 2003
February 2003
January 2003
December 2002
November 2002
October 2002
September 2002
August 2002
July 2002
June 2002
May 2002
April 2002
March 2002
February 2002
January 2002
December 2001
November 2001
October 2001
September 2001
August 2001
July 2001
June 2001
May 2001
April 2001
March 2001
February 2001
January 2001
December 2000
November 2000
October 2000
September 2000
August 2000
July 2000
June 2000
May 2000
April 2000
March 2000
February 2000
January 2000
December 1999
November 1999
October 1999
September 1999
August 1999
July 1999
June 1999
May 1999
April 1999
March 1999
February 1999
January 1999
December 1998
November 1998
October 1998
September 1998
August 1998
July 1998
June 1998
May 1998
April 1998
March 1998
February 1998
January 1998
December 1997
November 1997
October 1997
September 1997
August 1997
July 1997
June 1997
May 1997
April 1997
March 1997
February 1997
January 1997
December 1996
November 1996
October 1996
September 1996
August 1996
July 1996
June 1996
May 1996
April 1996
March 1996
February 1996
January 1996
December 1995
November 1995
October 1995
September 1995
August 1995
July 1995
June 1995
May 1995
April 1995
March 1995
February 1995
January 1995
December 1994
November 1994
October 1994
September 1994

ATOM RSS1 RSS2



LISTSERV.BROWN.EDU

CataList Email List Search Powered by the LISTSERV Email List Manager