Frontal Head Injury - Learning

[MDR55]

My son came to me at age 6 as a foster child and I adopted him at age 8, he is now 10. Early on I noticed an irregularity in his skull in the center of his forehead. He also seems to have a slightly large head circumfrence (kids bicycle helmets for his age are too small) He is intellingent in many ways but has learning difficulties, especially in reading. He also has difficulty remembering short term instructions. In his medical records there are 2 incidents of concern --at 9 months old he was taken to the ER for frontal head injury - he "fell down the stairs" according to the report. At 18 mos. he "ran into a concrete wall" and was taken to the ER. No MRIs or Xrays were taken on either visit - though his record indicates a "significant hemotoma" on forehead. Could this have been abuse? Could it be affecting his learning at this age? Should I have him tested medically (he has been cognitively tested) If so what tests? Is there research I can read that may give me insight to his problems if they are in part a result of these injuries?
THANK YOU!

[Joanna Fong, MD]

Hi MDR55,

Any child with learning disability or developmental delays should be evaluated formally by a pediatrician or pediatric neurologist.  Hematoma after head trauma can be significant, depends on the extend and size of the bleed.  I would encourage you to seek medical attention as soon as possible so interventions can be placed earlier.  Diagnostic testings should be individualized per your doctor's examination findings.  Large head can be a normal variants.  But other diseases can also cause enlarged head (macrocephaly) in a child - e.g. hydrocephalus (enlarged ventricles).  Imaging studies such as MRI brain can give us many important information about your son's brain anatomy and pathologies (includes hydrocephalus and the extent of the injuries as a result of the hematoma).

Good luck.  Thanks for using MedHelp.

THIS INFORMATION IS PROVIDED FOR GENERAL MEDICAL EDUCATION PURPOSE ONLY.  PLEASE CONTACT YOUR PHYSICIAN FOR DIAGNOSTIC AND TREATMENT OPTIONS OF YOUR SPECIFIC MEDICAL CONDITIONS.

[kg17]

Yes, you should seek evaluation from pediatric neurologist at a Children's Hospital.  Part of the eval. may entail a neuropsychological evaluation which would shed light on cognitive/learning difficulties.