Doctors Ignoring Basilar Skull Fracture? -Lost Parent

Posted by mrchristopher @mrchristopher, Apr 17, 2020

Hello, everybody. I just joined. I'm hoping for any feedback at all.

25 days ago my 13-month-old daughter fell off a bed 2.5 feet tall. There was a 12-inch gap between the bed and wall, and exposed wood on the side of the bed, with a carpet floor. We picked her up immediately and there was no sign of bruising anywhere, and she could move all parts of her body normally. There was never any irregular pupil sizes at any time. She has never had a temperature or fever then or since. She quieted down soon after we picked her up, and went to bed without incident that night. Since then she has undergone a complete personality change: she is inconsolable and generally unhappy, super clingy to only Mom, won't walk for fun (walking while holding our hands used to be an activity she enjoyed), won't independent play, pulls at her hair and puts her finger in her ears (or one ear, haven't paid attention to that), refuses to eat solid foods (before this she would eat a whole egg and avocado etc.), and suddenly cries or screams at random times during night and day. She has not cut any new teeth during these 25 days or for a month before.

Two days after the fall, she developed a large ugly bruise behind her left ear and back of head along with a dark bruise around her left eye on the same day. Both bruises appeared suddenly two days after the fall and faded slowly away after a week. One week ago she had a two-day period where she scratched frantically (lots of serious scratching) at the back of the bottom of her neck, the part just above where the neck merges with the shoulders/body. The scratching stopped after the two-day period.

I am in a very small rural town (where my parents live) for this quarantine period, with one hospital and several local physicians' offices. Two weeks ago we took my daughter to an orthopedic surgeon (a family friend and neighbor) who physically examined and pressed on her body everywhere and said if there was a fracture, it was occult and would heal on its own in three weeks, but that it was probably just teething. I told him about the bruising pattern, but he didn't think a fracture was likely in terms of overall probability.

Today we took her to another physician in emergency medicine, orthopedic surgery, and sports medicine for a second opinion. He said the same thing, that because it has been 25 days since the fall and she isn't showing any neurological problems, that the fall is unlikely the explanation for her behavior. I explained about the bruising pattern and runny nose every day since the fall (since it could be CSF leak), but he said a fracture was unlikely. He checked her heart, lungs, and ears, and found abnormal fluid in her left ear. He said it didn't look like a full-blown ear infection but the presence of abnormal fluid meant she was probably "right on the line" of having an ear infection. He prescribed an antibiotic (Azithromycin) and a antihistamine/decongestant mix (Children's Dimetapp Cold & Allergy, which is Brompheniramine Maleate and Phenylephrine). I noted that the fluid was in the same side of her head as the bruise pattern after the fall, but he said there was likely no connection.

The bruising behind my daughter's left ear perfectly resembles the Battle's sign bruising consistent with basilar/basal skull fractures and is very similar to images of Battle's sign online. The bruising around her left ear was not full-blown raccoon eyes, just extending around half of her left eye, but was very dark, appeared suddenly, and even now there is still markedly darker veins and blood flow to that same area around her eye.

I am very worried that she has a basilar skull fracture and it's going unnoticed by medical professionals. I recognize that I am a layman (trained in a field different than medicine), and I am fine with being completely wrong, but I am worried that the doctors have little experience with basilar skull fractures and are incongruous with recommended clinical decisions based on the criteria she is exhibiting, and I just want to cover all my bases because my daughter is so important and because it's sad seeing her so miserable for weeks on end.

Thoughts? What do I do next?

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@mrchristopher – Hi! Welcome to Mayo Clinic Connect. First- I understand how worried you are about your daughter. You have a good gut feeling. I have a background in Pediatrics and am very aware of the late developments after a fall like your daughter had. It definitely sounds suspicious of skull injury and possibly concussion. I know you are in a rural area, but she has to be seen ASAP at a major hospital center’s pediatric trauma center. You should call ahead and talk to someone, so they know what ails her. Please post back anytime ! I want to know how she is doing. It is very important that you plan to take her today. Call hospital first!


@mrchristopher – How are you doing? How is your daughter? If you have the time I would appreciate if you could give us a follow up. We have not forgotten- I have been very concerned and hope your daughter is doing well.


You were right: we did have a good gut feeling. And thanks for the advice. We took her to a major hospital with a trauma center and pediatric expertise, and she was discovered to have blood numbers consistent with leukemia. My wife and daughter were immediately airlifted to a well-known children's hospital specializing in pediatric cancer. The pathology of my daughter's particularly rare type of leukemia explained all the symptoms we had noticed, and we were congratulated for catching the cancer very early relative to most families. Her prognosis is very good now, with most of the risk hinging on bone marrow transplant success while avoiding as many permanent side effects as possible. Thanks again for the response and advice.


@mrchristopher – Thank you for your quick reply! I am sad that your daughter will have to go through treatment for leukemia, but she is at the best place possible. Children are very resilient. Leukemia can often masquerade as something different. Wishing her and you the very best outcome. She will be in my thoughts- we welcome updates!

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