Neuro: Big heads

So today saw a baby with hydrocephalus, an increase in the fluid around the brain. In adults, this condition is life threatening because if there is too much pressure... the brain gets pushed out the holes in your skull (called herniation). This means you will die if not treated.  But in a baby, the skull is not yet solid, so the fluid just stretches the skin around it and makes them look like they have a really really big head. I've included the CT and I'm sure you can imagine the rest....

Another interesting case, was a post-concussion syndrome. The theories on how to deal with a concussion have changed drastically in the last decade or so as we understand more about how the brain deals with injury.  They used to say keep your patients awake for the next 24hours because the were scared of brain bleeds. Then they decided as long as the patient could wake up every 2 hours over the next 2 days then they were fine... and now we say... let them sleep, as long as the CT in the ER is clean.

But some people exhibit symptoms beyond what the CT shows. One guy 26y.o. M who had fallen off a roof a week ago and the chimney (which he was tied to) fell on him! He was miraculously ok, but went to the ER and told to go home after an extensive workup. He was able to sleep but he was constantly dizzy and being macho didn't admit it to anyone. He ended up falling down the stairs hitting his head AGAIN on cement. When i saw him he had a personality change, he was more dull (showing no emotion on his face).  He couldn't concentrate enough to count to 10, made lewd comments at me and he was very very angry for essentially no reason. Also the MRI of his brain was clean. This is called post-concussion syndrome. The brain sustained too many bruising injuries and decided to rearrange things to allow other parts to heal (as the neurologist explained).  While this happens he will be this way, it can take up to 3 months to get back to normal. And he will always be more prone to falling injuries (once you get one concussion you're more likely to get another).  The more concussions he gets the more problems his brain will have. Interesting tho, right?