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Saw this three nights ago.
Three month old with soft swelling over the skull.
Completely normal neuro exam 
Parietal skull fracture with a bit of fresh blood beneath the fracture.
No history of trauma at home
Maybe at the sitters?
Evaluation by child protection is ongoing.
I listen to the history and then get the head CT scan in any case.
Actually feel it is more important to scan the patient who doesn't have a history of trauma than one who does.
A small fracture in a normal infant with a history of trauma to explain it, the scan is unlikely to change the management
A small fracture in a normal infant with no history of trauma, the scan will dfinitely change management

Jim LIndsay
PICU
Emanuel Children's Hospital


-----Original Message-----
From: Pediatric Emergency Medicine Discussion List on behalf of Joe Nemeth, Mr
Sent: Mon 3/30/2009 12:33 PM
To: [log in to unmask]
Subject: Re: am i missing sumthin?
 
Beware....
 
Saw this recently...
 
Same story...no Hx of trauma...
 
Dg: Skull #, Trauma X 
 
Joe
 
 
Joe Nemeth MD CCFP EM
Director,
Emergency Medicine
Montreal General Hospital
Assistant Professor
Pediatrics
Montreal Children's Hospital
McGill University Health Center
[log in to unmask]
Tel: 1-514 299 6190
Fax: 1-514 934 8421
 

________________________________

From: Pediatric Emergency Medicine Discussion List on behalf of Lyn Dos Santos, MD
Sent: Mon 3/30/2009 2:52 PM
To: [log in to unmask]
Subject: Re: am i missing sumthin?



Leptomeningeal cyst??  I have only seen one in the last 15 years so I
know it is rare.  Since this follows a skull fracture by weeks/months
there is often no other sign of trauma.  Did you get a head CT? 

Dr. Lyn Dos Santos
Clinical Assistant Professor
Department of Pediatrics, Stanford University
Director, Pediatric Hospitalist Program
Washington Hospital
2000 Mowry Ave
Fremont, CA 94538
510-795-2002
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-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]] On Behalf Of don zweig
Sent: Monday, March 30, 2009 7:42 AM
To: [log in to unmask]
Subject: am i missing sumthin?

11 m old prev healthy girl brought in by two very appropriate 
intelligent parents; sent in by pediatrician after seen for a soft 
spot on left temp parietal portion of skull that began misteriously 
this am.  they are with child constantly and there has been no 
trauma.  child is acting normal and is playful and into everything and 
very cute.  there is no nv. on exam she has a surprise temp of 38.7 r 
and other vitals normal but no bp taken.  she has a normal fontanel 
but on the left side of scalp is an area maybe 3x3 inch of non tender 
soft fluid filled area like a hematoma but no discoloration/tenderness 
or abrasion.  no battles raccoon and the remainder exam is entirely 
normal.  what would you do?

don

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