Grand Larceny in the First Grade: Traumatic Brain Injury in the School-Aged Years

Abstract

Cody was the well-behaved, endearing, mild mannered, normally developing, 6-year-old girl any family would be blessed to have. The weather held the first sign of spring, and Cody 's mother was returning home from running errands with her only daughter, who just came along for the ride and to get out of the house. Cody was seat belted and well secured in the vehicle, as she is every time she goes on a family outing. As the car rounded the corner just before the family 's house, it slid and deviated into the shoulder of the road, rolling over. After the car stopped, Cody 's mother, who did not experience any loss of consciousness, exited the car and took stock of the situation. Somehow during the event, Cody had slipped from the grasp of her seat belt and gone through the side window, and she was ultimately found unresponsive several feet from the car. Cody 's mother, in a well-appreciated panic, scooped up her child and rushed to the closest neighbor 's house. After a quick call to 911, a helicopter arrived at the scene, and Cody was off to the local regional medical center. The initial Glasgow coma score en route to the hospital was 6, suggesting a severe brain injury (Table 3.1).

Cody was initially spontaneously breathing on the scene, although at some point during the initial moments of hospitalization, her status declined and she required intubation. A computerized tomography (CT) scan of the head revealed active bleeding within aspects of the right frontal lobe, as well as the right middle portion of the base of the skull, extending to the right side of the skull. A small amount of subarach-noid blood and a moderate amount of subarachnoid air also were present, as a hematoma within the brain tissue. An increase in cerebrospinal fluid (CSF) necessitated a temporary catheter to relieve the pressure. Cody was ultimately stabilized and eventually extubated. A compounding injury during the crash was an extensive skull fracture of the facial bones, with the force of impact centering just above her right eye. Even though the long healing process was just beginning, there was already some mention that Cody might lose vision in the right eye. Cody 's mother recalls that when she first heard these details, she did not care about broken bones or the possible vision loss, only that her daughter awaken from her coma. Once she returned from this unintended sleep, Cody 's mom was sure she would have her daughter back.