This child was 10 years old when he initially presented to the hospital.  He was with his grandmother when he began complaining of a headache, after which he lost consciousness. His grandmother called the paramedics but the sheriff got to the house first.  The sheriff found the child not only unresponsive but also not breathing. According to the sheriff, he was purple. He initiated CPR and was able to get his pulse back. The sheriff saved him!

He was brought into the emergency room and was intubated.  He had a CT scan of the brain that showed an intracranial hemorrhage.  During the time in the ER, he arrested again and was brought back.

The ER called me after the CT scan on the way up to the Pediatric ICU.

I met him and his family in the ICU.

His CT head showed blood in the cerebellum with compression of the brain stem. There was also some hydrocephalus. His CT angiogram showed an associated arteriovenous malformation that had caused the hemorrhage.

This child was 3 months old when she presented to the emergency room with evidence of increased pressure inside of her head.  She had rapid head growth and the soft spot at the top of her head (anterior fontanelle) was tense.  Interestingly, she had multiple skin lesions that were consistent with cutaneous hemangiomas.

Based on her clinical condition, she underwent a CT scan of the brain, followed by an MRI of the brain. We could not do a contrast MRI since she was allergic to the contrast material for the MRI but we did a contrast CT and MRI without contrast. For a lot of tumors, it’s easier to see the tumors with the contrast dye but we had to proceed without it.