An 18 month old male was brought in by paramedic following a seizure while at the babysitters house. The child was afebrile and extremely lethargic, so a febrile seizure was quickly ruled out.
The babysitter stated the child had been ill with an URI and had some episodes of vomiting earlier that day.
The presentation was not consistent with any of the things you might expect with the presentation (a HUGE key point in child abuse/ if the history is inconsistent with the findings, child abuse should be addressed).
We did a drug screen on him thinking he may of gotten into something which was negative. With no conclusions after the work up and the child remaining extremely lethargic as well as some posturing noted now, I took him for a CT scan.
Imagine our surprise when the CT scan showed multiple skull fractures in varying stages of healing and a subdural hematoma!!
Abuse was something that never crossed any of our minds. The child ended up going for neuro surgery to evacuate the hematoma and ended up doing fine.
Truly a very good lesson for all involved.
Forensic Nursing Chronicles 