ABSTRACT
Case Presentation ................................................................................................... 257 Differential Diagnosis ............................................................................................ 259 Diagnostic Approach ............................................................................................. 259 Treatment Strategy .................................................................................................260 Long-Term Outcome .............................................................................................. 261 Pathophysiology ..................................................................................................... 261 Clinical Pearls ........................................................................................................ 262 Suggested Reading ................................................................................................ 262
A previously healthy 12-year-old right-handed female fell while riding horseback and sustained moderate traumatic brain injury (TBI). The primary point of impact was the left temporoparietal area. She suffered a 10-minute loss of consciousness, and her Glasgow Coma Scale (GCS) was 12 (E4, M5, V3) on arrival to the emergency room 2 hours later. Despite her altered state, her neurological examination was nonfocal, and did not show clinical signs of increased intracranial pressure requiring aggressive medical or surgical management. Her head computed tomography (CT) showed two left temporal punctate contusions and a 2 × 3 cm right temporal intraparenchymal hematoma with subarachnoid hemorrhage and subdural hemorrhage along the tentorium. She developed several early posttraumatic seizures (EPTS) that were generalized tonic-clonic convulsions, but did not have status epilepticus. These were controlled with phenytoin. After 2 days, she was discharged home with a postconcussive syndrome, but an otherwise nonfocal neurological examination.
