Case 4: Stroke after Minor Trauma in an Otherwise Healthy 18-month-old Boy.

1. Cherilyn Cecchini, MD* 2. Sabah Iqbal, MD† 3. Jonathan Murnick, MD, PhD* 1. *Departments of Pediatrics, Radiology, and 2. †Pediatric Emergency Medicine, Children's National Health System, Washington, DC A previously healthy 18-month-old boy presents to the emergency department (ED) after a fall. His parents reported that the father was carrying the child down the stairs when he slipped 1 step from the bottom; the child fell out of his arms and landed on his chest on the hardwood floor. The child did not lose consciousness and he cried immediately, but several minutes later his mother noticed that he seemed “dazed.” Emergency medical services was called, and the child was alert and awake on their arrival. The child arrived at the ED 3.5 hours after the fall given the family’s remote location. During his initial examination he was sitting in his mother’s arms with his head held midline and was moving all 4 extremities. The remainder of his examination findings are normal. His mother is very worried that “something” is wrong. He is stratified as intermediate risk for traumatic brain injury, and the decision is made to observe him in the ED. After a trial of oral intake, he stood up to walk, at which point he is noted to be slightly antalgic. Shortly …