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    Infant’s seizures and skull fracture could point to child abuse

     

    Patient outcome

    After a multidisciplinary review of the case, additional volumetric reformats of the calvarium were created to provide a 3-D view of the patient’s skull (Figure 2). The reformats revealed that the appearance of the asymmetric linear lucency in the right parietal calvarium was more suggestive of an accessory suture than an acute fracture.

    Findings were later explained to the family. The patient experienced no further seizure activity and was diagnosed with a complex febrile seizure episode. He remained afebrile with antipyretic use and free of symptoms. On day 2 of his hospitalization, the patient was discharged home in stable condition with directions for supportive care and routine follow-up with his primary care pediatrician.

    Next: Look through the lens of trauma

    References

    1. Christian CW, Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of suspected child physical abuse. Pediatrics. 2015;135(5):e1337-e1354.

    2. Flaherty EG, Perez-Rossello JM, Levine MA, Hennrikus WL; American Academy of Pediatrics Committee on Child Abuse and Neglect; Section on Radiology, American Academy of Pediatrics; Section on Endocrinology, American Academy of Pediatrics; Section on Orthopaedics, American Academy of Pediatrics; Society for Pediatric Radiology. Evaluating children with fractures for child physical abuse. Pediatrics. 2014;133(2):e477-e489.

    3. Ubhi T, Reece A, Craig A. Congenital skull fracture as a presentation of Menkes disease. Dev Med Child Neurol. 2000;42(5):347-348.

    4. Shin JJ, Lee JP, Rah JH. Fracture in a young male patient leading to the diagnosis of Wilson's disease: a case report. J Bone Metab. 2015;22(1):33-37.

    5. US National Library of Medicine. Genetics Home Reference. Osteopetrosis. Available at: https://ghr.nlm.nih.gov/condition/osteopetrosis. Published September 5, 2017. Accessed September 7, 2017.

    6. Paterson CR. Fractures in rickets due to vitamin D deficiency. Curr Orthop Pract. 2015;26(3):261-264.

    7. Parisi MT, Wiester RT, Done SL, Sugar NF, Feldman KW. Three-dimensional computed tomography skull reconstructions as an aid to child abuse evaluations. Pediatr Emerg Care. 2015;31(11):779-786.

    8. Nakahara K, Miyasaka Y, Takagi H, Kan S, Fujii K. Unusual accessory cranial sutures in pediatric head trauma—case report. Neurol Med Chir (Tokyo). 2003;43(2):80-81.

    9. Fleece DM, Kochan PS. Skull fracture in an infant not visible with computed tomography. J Pediatr. 2009;154(6):934.

    10. Sanchez T, Stewart D, Walvick M, Swischuk L. Skull fracture vs accessory sutures: how can we tell the difference? Emerg Radiol. 2010;17(5):413-418.


    Zoabe Hafeez, MD
    Dr Hafeez is assistant professor of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston ...
    Mykael Garcia, MD
    Dr Garcia is a pediatric chief resident at St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania.
    Maria D McColgan, MD, MSEd, FAAP
    Dr McColgan is associate professor of Pediatrics at Rowan University School of Osteopathic Medicine, Stratford, New Jersey, and Drexel ...

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