What seemed like an ordinary stumble during playtime quickly escalated into a critical medical emergency for a 27-month-old girl who developed an epidural hematoma. Despite being alert immediately after the fall, the toddler required life-saving neurosurgical intervention after severe delayed symptoms surfaced.
A Common Household Fall with Hidden Consequences
The National Hospital for Tropical Diseases recently treated a 27-month-old female patient, identified as V.N.M.C. from Phu Tho Province, who sustained a traumatic head injury after slipping while playing at home.
During active play, the toddler slipped and struck the back of her head against a hard floor, resulting in localized swelling in the occipital region. Although she remained conscious, her cautious family promptly took her to a local healthcare facility for an evaluation. An initial cranial CT scan indicated a left occipital epidural hematoma. Over the next several hours, the child experienced intermittent headaches.
Children can experience delayed complications from head injuries even if they appear stable initially.
Following an initial 24-hour observation period, the toddler’s condition appeared stable, and she was discharged home for ongoing parental monitoring. However, once home, her condition deteriorated rapidly. The child became unusually fussy, refused food, grew excessively lethargic, and suffered repeated bouts of nausea and projectile vomiting. Recognizing the life-threatening danger, her parents rushed her straight to the National Hospital for Tropical Diseases.
Emergency Neurosurgery Averts Permanent Brain Damage
Dr. Ta Viet Phuong, a specialist at the Department of Traumatic Brain Surgery who led the surgical team, noted that the patient was admitted with delayed responsiveness, a Glasgow Coma Scale score of 14, prominent occipital swelling, poor appetite, lethargy, persistent vomiting, and severe episodic head pain.
Surgical team performing emergency hematoma evacuation on the posterior cranial fossa of the young patient. (Photo: Hospital Provided)
An emergency repeat brain CT scan revealed an expanding left occipital epidural hematoma measuring 3.8 cm x 4.2 cm with a hematoma thickness of 2.5 cm, accompanied by surrounding cerebral edema, a left occipital skull fracture, and hemorrhage in the left posterior fossa. Given the rapid progression and imminent risk of herniation, the medical team immediately performed an emergency craniotomy to evacuate the hematoma.
Thanks to the rapid clinical decision, the operation succeeded. Three days post-surgery, the young girl made a remarkable recovery: breathing independently, eating and sleeping well, with all motor skills and cognitive functions fully preserved.
Crucial Warning Signs Parents Must Never Ignore
Drawing from this harrowing incident, Dr. Ta Viet Phuong advises parents and caregivers never to take childhood falls lightly, even if the impact seems minimal. Domestic accidents such as falling backward onto hard tiles, collisions during play, or pool-related mishaps can all result in varying severities of traumatic brain injuries (TBI).
Key symptoms requiring immediate emergency medical care:
- Persistent or worsening headaches: Continuous crying, head-holding, or sharp episodic pain.
- Gastrointestinal distress: Recurrent nausea or repeated vomiting.
- Altered consciousness: Extreme drowsiness, difficulty waking up, slow reaction times, or confusion.
- Behavioral shifts: Inconsolable irritability, sudden loss of appetite, or uncharacteristic lethargy.
Certain intracranial hematomas expand gradually without causing immediate unconsciousness. Delaying medical consultation during this critical window can lead to irreversible neurological damage or fatal outcomes. Caregivers must seek professional medical intervention promptly whenever an abnormal symptom appears after a head injury.
