Monday, September 5, 2011

Tales from Residency: Brain Injury

I didn't do a lot of pediatrics during residency (and none now), but during my short stints dealing with pediatric rehab patients, I noticed an important thing: normal pediatric patients are very difficult to distinguish from brain injury patients. You could probably create a scale that corresponds severity of a brain injury with the age of a kid that the patient acts like.

For example, this was my experience examining an 11 year old boy who we thought might have a traumatic brain injury:

When we were testing his proprioception (which basically means can he tell where parts of his body are in space), we placed a barrier in front of his foot and lifted his toe up or down and having him tell us which way it was pointed. Or as my attending said, "Is your toe pointing towards you or towards the wall?"

The kid was absolutely unable to give a straight answer to this question. Each time (and we did this ad nauseum), he told us everything he could think of that his toe was pointing towards.

Attending: "Is your toe pointing towards you or towards the wall?" (Answer: the wall)

Kid: "Well, it's pointing towards my dad, the wall, that sign, the bathroom, the edge of the bed, and... the door."

Attending: "Is your toe pointing towards you or towards the wall?" (Answer: toward him)

Kid: "Well, that's a trick question because it's really more pointing towards the window, the light, the dresser, my games, and a little towards me."

If an adult answered 10 straight questions in a row like that, I would think that they definitely had a traumatic brain injury. But for an 11 year old kid, we decided it was normal. Annoying, but normal.

And then at some point, the kid took out a robot toy from home that fired little pellets at the wall. I was so relieved when he ran out of pellets, but then he reloaded it. All I could think was, thank god I have a girl.


  1. Sex has nothing to do with it. My daughter is a WMD.

  2. My husband commented this afternoon driving home that all teenagers everywhere were the same. All are obnoxious and annoying. Still, there's something about that pre-pube mustache and the fact that you know what they do when they lock themselves in their rooms that makes adolescent boys especially revolting.

  3. When Wash had his first brain tumor surgery he was able to tell jokes several hours after waking up but it was almost two weeks before he could remember or even say the correct hospital where he was.
    Did you specify which toe- maybe he was telling you all of them!?

    /Nerf gun fanatic when I was around that age

  4. When I was eight or nine, I was sitting at the eye doctor's, having the interminable "this one... or this one?" prescription adjustment in the chair. Even in my 20s and 30s I often can't tell which one is better. Back then, I just said "there's a subtle difference..."

  5. And when one gets older, acquires a drivers license, and a knowledge of some basic chemistry, the toys get a lot more interesting, illegal, and far more noticeable.

  6. I remember when our grandson got hit by a car when he was about 6. The next day, the eye doctor came to see about his vision.

    Doc: "Can you read the letters on this card?"

    Grandson (scornfully): "Those aren't letters, those are numbers."

    Doc's medical conclusion: eyes AND brain appeared to be functioning.

  7. He was probably suffering from youthful tendency disorder:,248/