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Right Sided Jerking And Decreased Appetite


Consult Page

2 month old with right sided jerking and decreased appetite

Initial Imaging

Fig. 53.1, Head CT without contrast demonstrates a left acute convexity subdural hematoma (A) extending to the falx and left temporal fossa (B), a right sided small falcine subdural hematoma (B), and a linear nondisplaced left parietal skull fracture (C, D).

Fig. 53.2, MRI brain without contrast diffusion sequence demonstrates extensive diffusion restriction of the left frontal, temporal, parietal, and occipital lobes, compatible with acute infarction. When taken together with the patient’s bilateral subdural hematomas, this is concerning for nonaccidental trauma.

Walking Thoughts

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    Has the trauma team performed an initial assessment with attention given to the ABCs (airway, breathing, circulation)?

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    What is the mechanism of injury?

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    What is the child’s GCS and neurological status?

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    Is there concern for elevated intracranial pressure?

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    What is this child’s past medical history?

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    Are there any risk factors for nonabusive causes or risk factors for intracranial bleeding?

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    Is there concern for nonaccidental trauma?

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