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CT scan showing undepressed fracture of right temporal bone. Child having vomiting problem. What do you suggest?

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Neurologist, Surgical
Practicing since : 1996
Answered : 138 Questions
Dear doctor, My 5 year old daughter fell down on a slippery floor at home (not from any height). When we went to the Pediatrician, she advised a CT scan yesterday which revealed a 1. Small Acute EDH in the right temporoparietal Region and undepressed fracture of right temporal bone. We took her to Nimahns hospital and they diagnosed it to be a minor clot and fracture and no special treatment is required apart from Ibugesic for pain and Ondem for stopping the vomit and advised us to bring the child if there is persistent vomiting. She vomited once today and is little restless and not playing the way she does usually. She is also complaining of little. Otherwise, she responds well, talks normally and looks clinically fine. Should we go for a second opinion on this case doctor? I am asking this majorly because the doctor who saw my daughter was a duty doctor at Nimhans and is not approachable by phone. Also advice us with certain alarming signs we have to look out for. Can this be processed on priority please?
Posted Sat, 30 Nov 2013 in Head Injuries
Answered by Dr. Praveen K Nath 3 hours later
Brief Answer: ACUTE EDH SMALL Detailed Answer: DEAR XXXX I have gone through your daughter's history in detail . Thin acute EDH in a 5yrs baby needs close watch & observation at least for initial 4-5 days . If she has vomited & is not playful. May I suggest you to 1.Consult a neurosurgeon at NIMHANS/ private who can examine her neurological status and look for any deterioration . 2. Get a repeat non contrast CT head to see any increase in size /mass effect of EDH . 3. Continue giving analgesic & antiemetic medication to get symptomatic relief 4. If repeat CT HEAD is normal ,keep the baby at home 5. If CT HEAD has increase in size of EDH or increase cerebral oedema , she might need hospitalization . Hope this helps. I pray for her speedy recovery... Dr XXXXXXX k XXXXXXX Director Deptt. of neurosurgery
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Follow-up: CT scan showing undepressed fracture of right temporal bone. Child having vomiting problem. What do you suggest? 38 minutes later
Thanks for the reply doctor. She vomited only once but has been complaining about headache. She is usually reluctant to travel by car as she is prone to Nausea during car drives. Please let me know if we can observe till tonight or should I probably take her to Manipal Hospital which is close by for us? If hospitalized, may I know how she will be treated and is there is threat as such. I am sorry to pester you too much but as a parent I am very worried this being a head injury
Answered by Dr. Praveen K Nath 31 minutes later
Brief Answer: ACUTE EDH Detailed Answer: DEAR XXXX You can go to Manipal hospital if it is nearby , or at least go for a repeat CT SCAN at any nearby scan center to see if there is any increase in size of EDH . If size is same /smaller you can continue observation at home during night & consult a neurosurgeon later. If EDH size has increased / she develops drowsiness/ recurrent vomitings/not accepting feeds / not playful ,then contact some doctor/pediatrician. Even if small EDH increases in size , it needs observation/medical treatment . Surgical treatment is only needed for very large EDH. So nothing much to worry about ,but keep an observation . Thanx Dr XXXXXXX k XXXXXXX
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Follow-up: CT scan showing undepressed fracture of right temporal bone. Child having vomiting problem. What do you suggest? 3 hours later
Dear Doctor, As per your advice took my daughter to the nearest Neuro Clinic Plexus Neuro and Stem Cell Research Centreā„¢ in XXXXXXX town. The Neurologist Dr. Naeem XXXXXXX examined the report and saw my daughter and said there is nothing to worry as the size of the clot/fracture is only 0.8 cms as per the CT scan taken yesterday around 7:30 pm. Also suggested that Vomiting & pain on the head is common due to the impact. Along with the Ibuprofen and Ondem, he also prescribed Glyserol Oral to help suppress the pain. He has asked us to visit him on Monday morning and has suggested an intravenous intervention on Monday, if the symptoms continue. Meanwhile, he has asked us to not panic and not show too much of concern in front of the baby, although monitoring her carefully. He has also suggested a chewable tablet, if seizures to be spotted. As the baby had fright to go to Manipal Hospital, which is 7 kms away, we went to this clinic through our Neighbor's reference
Answered by Dr. Praveen K Nath 1 hour later
Brief Answer: ACUTE EDH Detailed Answer: Hi, I am relieved as baby has been examined by a neurologist & she is stable, You should continue with oral glycerol.& get a repeat NCCT HEAD on monday. Continue observation as advised. Thanks, Dr XXXXXXX k XXXXXXX
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Follow-up: CT scan showing undepressed fracture of right temporal bone. Child having vomiting problem. What do you suggest? 22 hours later
As a follow up doctor. My Daughter Srinaya is slightly better. Apart from complaining about the headache all through the day, she didn't have other complaints. She refused taking Glycerol right from yesterday, as she puked after having it the first time. We even tried mixing it up with water and giving it but she identified it and puked once today (Only because of tasting Glycerol). She played from sometime and slept well. Only the persistent pain on head, she has, is bothering her. I think the headache is not too bad considering she manages to sleep. Is it not that we can't sleep with excruciating headache? As we are meeting the Neurologist tomorrow, we might ask him for an alternative to Glycerol as she is not comfortable with it. 1. So currently she continues with Ondem (15 mins before food), Crocin (Neurologists suggested even Crocin is fine if baby finds Ibuprufen bitter). 2. Had three meals (Maggi twice & one roti for dinner) and 1/4 tumbler of Mosambi Juice. How long the headache continue doctor? Is she getting better medically? Should I insist for another CT Scan as the Neurologist has recommended it so far? You have been a great help to me so far Doctor :)
Answered by Dr. Praveen K Nath 43 minutes later
Brief Answer: ACUTE EDH Detailed Answer: DEAR MR XXXX HELLO Good to know that your daughter is doing well. Mild headache without vomiting is not a cause of worry . If there are recurrent vomits or progressively increasing headache ,then we need a repeat CT HEAD to rule out increase in size of EDH. Normally headache may continue for 4-5 days . I would still suggest a repeat CT HEAD for baby as she is a kid & may not be able to tell you about severity of headahe ,& further you,ll be relieved after getting a repeat scan . Further if glycerol is at all needed after repeat CT SCAN , you may give it mixed with fruitjuice/limca etc. Wishing a speedy recovery Thanx Dr XXXXXXX k XXXXXXX
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