Concerns About Delayed Brain Hemorrhage in a Toddler After a Fall

Q: Concerns About Delayed Brain Hemorrhage in a Toddler After a Fall

Hello： CT scans involve radiation, so please return to Taiwan for a consultation. <br>It is best to visit a large hospital that is a medical center with a pediatric neurosurgery department. <br>Wishing you well, Neurosurgeon Dr. <br>Lai Chao-Kang.

A 1 year and 5 month old baby fell and hit their head, and currently cannot put weight on their left foot properly?

Hello Doctor: My baby girl (1 year and 5 months) fell on the afternoon of April 9th and has been unable to stand normally since then.
When she tries to stand, her left leg always curls up, and she is either afraid to put weight on it or cannot put weight on it.
On April 10th, she had a CT scan of her brain and an X-ray of her foot, both of which showed no issues.
We visited two hospitals in mainland China, and both advised to continue observation.
She just learned to walk this week, and she has no problems playing while sitting or crawling.
Sometimes, when she stands with support, she can still kick with her left leg and even uses her left leg to climb the railing.
However, she cannot stand independently.
On April 12th, while wiping her nose at noon, I noticed blood streaks in her left nostril, while there were no blood streaks in her right nostril.
Could this be a symptom of delayed intracranial hemorrhage? If a CT scan is needed again, how long should we wait before scheduling it? Since she is a small child, I am concerned about the frequency of CT scans.
We are considering returning to Taiwan for examination and treatment; which department should we consult in this situation?

Harry, 30~39 year old female. Ask Date: 2018/04/12

Dr. Lai Zhaokang reply Neurosurgery

Hello: CT scans involve radiation, so please return to Taiwan for a consultation.
It is best to visit a large hospital that is a medical center with a pediatric neurosurgery department.
Wishing you well, Neurosurgeon Dr.
Lai Chao-Kang.

Reply Date: 2018/04/12

More Info

Concerns about delayed brain hemorrhage in a toddler after a fall are understandably alarming for any parent. In your case, your daughter, who is just 1 year and 5 months old, experienced a fall that has led to some concerning symptoms, including difficulty standing and the presence of blood in her nasal discharge. Let's break down your concerns and provide some guidance based on medical knowledge.

Delayed Brain Hemorrhage
Delayed brain hemorrhage, particularly in children, can occur after a head injury, even if initial imaging (like a CT scan) does not show any immediate issues. The symptoms of delayed hemorrhage can include changes in consciousness, persistent headache, vomiting, seizures, or neurological deficits such as weakness or difficulty with coordination. In toddlers, it can be challenging to assess symptoms accurately, as they may not be able to articulate their feelings or symptoms clearly.

Symptoms and Timing
In your case, the fact that your daughter is unable to stand normally and has developed blood-tinged nasal discharge raises some concerns. While the blood in the nasal discharge could be due to a variety of reasons, including minor trauma or irritation, it is essential to consider it in the context of her recent fall. The inability to stand properly could indicate a possible neurological issue, and the presence of blood could suggest that further evaluation is warranted.

Recommendations for Imaging
Regarding your question about when to arrange for another CT scan, it is generally recommended to monitor for symptoms for at least 24 to 48 hours after the initial injury. However, if new symptoms arise—such as the blood in the nose, worsening coordination, or any signs of increased intracranial pressure (like persistent vomiting, severe headache, or altered consciousness)—it would be prudent to seek immediate medical attention. In young children, the threshold for repeat imaging is lower, especially if there are concerning signs.

Frequency of CT Scans in Young Children
CT scans involve radiation exposure, which is a significant consideration in young children. Therefore, they are typically only performed when necessary. If your child is showing concerning symptoms, the benefits of obtaining a CT scan to rule out serious conditions would outweigh the risks associated with radiation exposure. Always discuss the risks and benefits with your healthcare provider.

Seeking Further Evaluation
If you are considering returning to Taiwan for further evaluation, it would be advisable to consult with a pediatric neurologist or a pediatric emergency medicine specialist. These specialists can provide a thorough assessment of your child's condition and determine whether further imaging or interventions are necessary.

Conclusion
In summary, while your daughter's initial CT scan did not show any issues, her current symptoms warrant close observation and possibly further evaluation. If you notice any worsening of her condition or new symptoms, do not hesitate to seek immediate medical care. It is always better to err on the side of caution, especially with young children. Your child's health and safety are the top priority, and ensuring she receives the appropriate care is crucial.

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