Child with terrible vomiting. Had a intestinal blockage and swollen lymph nodes in abdomen. Done MRI and CT scan

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Posted on Fri, 25 Oct 2013 in Brain and Spine
Question: My 8 month old grandson was ill with terrible vomiting for over a week and was seen numerous times by medical professionals and even hospitalized. His parents were told he had a virus. Many of his labs were high including platelets and white blood count. He seemed to finally improve and then all of a sudden became lethargic while at daycare. His parents were then told he had a intestinal blockage and swollen lymph nodes in his abdomen. He hadn't passed stools for several days. He then started having seizures. After an MRI and CT scan it was determined he had subdural hematomas, bilateral frontal hygromas, right transverse sinus irregularity, and a right parietal diffuse image abnormality suggestive of ischemic changes but very subtle. The doctor noted the findings were not definite in themselves of non-accidental trauma but later was ruled non-accidental trauma due to retinal hemorrhaging. However, the only treatment he needed was IV fluids and anti seizure medication. He recovered remarkably. Then in a couple of days he developed a slight fever and rash and returned to the hospital. A CT scan was ordered and they decided the blood clot was getting larger and the fluid from his brain needed drained so he went through surgery. It seems strange to me that when hospitalized this time he was completely normal acting and supposedly had so much fluid building it needed drained. But during the previous hospitalization he was unconscious for days and didn't need any fluid drained or treatment for swelling. Matter of fact no swelling of the brain was ever mentioned. Then after this surgery it was decided that instead of having a "new injury" and "old blood" that he actually had only the "new injury" as what was thought to be the "old blood" was actually just CSF. Also, it was "determined" that the previous vomiting episode for 1.5 weeks was an unrelated illness. How confusing and how can anyone trust the constant changing views?? Also, trying to prove what happened to him and who did it is extremely difficult. He had no other injuries to his neck or spine or any other broken bones, cracks, or bruising. He has always had what appears to be a large head but after looking at medical records it appears his head size did increase in percentiles over time...started out in 25th percentile at birth and then 95th percentile a few weeks prior to onset of illness. I know they are saying non-abusive head trauma but how can that be proven OR does he have something else wrong with him that everybody is missing?? I would hate for this to all happen again because he has an illness or abnormality and he end up sick again or dead.
doctor
Answered by Dr. Sudhir Kumar 27 hours later
Brief Answer:
It appears to be subdue all hematoma

Detailed Answer:
Hi,

Thank you for posting your query.

I have gone through the details of your grandson. It appears to be a case of subdural hematoma (SDH) due to trivial trauma. I agree with you that it is difficult to tell with certainty, but abuse seems unlikely, as there are no external injury marks.

Generally, SDH is monophasic illness, and does not repeat again. Also, very small babies withstand pressure in the brain due to SDH a lot, as the skull bones have not fused, and so, the signs such as vomiting, decreased consciousness, etc may be absent.

So, there is no need to worry at present about the diagnosis, and also the future risk of recurrence of something similar.

I hope it helps. Please get back if you have any more queries.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudhir Kumar 39 minutes later
I'm confused. What do you mean by trivial trauma? Why do you think abuse is unlikely? What else could have caused this?
doctor
Answered by Dr. Sudhir Kumar 5 minutes later
Brief Answer:
My reply is below

Detailed Answer:
Thank you for getting back.

By trivial trauma, I mean accidental hitting on the wall or falling on the floor.

Abuse is unlikely as children with abuse tend to have multiple injuries including fractures, soft tissue with external bruises in addition to head injury, which are not there in this case.

Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudhir Kumar 4 minutes later
So what could have caused this? Also, what could have caused the retinal hemorrhaging?
doctor
Answered by Dr. Sudhir Kumar 20 minutes later
Brief Answer:
Could be due to injury or bleeding disorder

Detailed Answer:
Thank you for getting back.

The injury related cause has been discussed.

In addition, we need to exclude a bleeding disorder that can cause both SDH and retinal hemorrhage. Common bleeding disorders are due to low platelet count, platelet dysfunction, low vitamin K, etc. A hematologist can help in that.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Sudhir Kumar

Neurologist

Practicing since :1994

Answered : 5945 Questions

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