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Unrecognized microscopic hyphema masquerading as a closed head injury
D K Coats1, E A Paysse, J Kong
1Cullen Eye Institute, Baylor College of Medicine, Texas Children's Hospital, Houston 77030, USA.
Pediatrics
|September 17, 1998
Summary
A child’s neurological symptoms were misdiagnosed as a head injury due to an unrecognized microscopic hyphema and acute glaucoma. Prompt ophthalmologic exams are crucial for children with trauma history to prevent misdiagnosis of ocular conditions.
Area of Science:
- Ophthalmology
- Pediatric Neurology
- Emergency Medicine
Background:
- Pediatric head injuries can present with non-specific neurological symptoms.
- Ocular trauma is a potential cause of such symptoms, sometimes overlooked.
- Sickle cell trait can be associated with ocular complications.
Observation:
- A child with sickle cell trait presented with symptoms mimicking a closed head injury.
- Initial evaluation included head CT and lumbar puncture, consistent with head trauma management.
- Ophthalmologic consultation revealed microscopic hyphema and acute glaucoma.
Findings:
- The child's neurological signs and symptoms were directly caused by occult ocular injury.
- Microscopic hyphema and acute glaucoma were the underlying conditions.
- The ocular injury was initially unrecognized, leading to misdiagnosis.
Implications:
- Children with neurological symptoms and a history of trauma require prompt ophthalmologic evaluation.
- Undetected hyphema can lead to acute glaucoma, mimicking head injury.
- Early diagnosis of ocular conditions is vital to prevent misdiagnosis and ensure appropriate treatment.