Presentation
Accidental fall from a 1-meter high counter onto a concrete floor. The child has a GCS of 3 in the ER.
Patient Data
Normal orbits. There is a small extra-axial hemorrhage in the right posterior frontal region. There is a small amount of acute subdural hemorrhage along the falx, There is a small amount of subarachnoid hemorrhage at the vertex. There is normal gray/white differentiation.
Seven hours later. The acute subdural and subarachnoid hemorrhages are unchanged. There is generalized brain edema with poor gray/white differentiation. Retinal/vitreous hemorrhage is seen in both eyes, right worse than left.
Case Discussion
This child developed DIC in between the admission head CT scan and the second study seven hours later. Retinal hemorrhages can be seen on MR susceptibility weighted imaging in infants who have intracerebral hemorrhage or increased intracranial pressure. These hemorrhages are rarely seen on head CT.
The child died the next day. Cerebral edema, subdural and subarachnoid hemorrhage, and retinal and vitreous hemorrhages were confirmed on autopsy.
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