An 18-month-old boy from Pune has shown a significant and rare recovery after suffering a severe head injury from a fall off the third floor of a building, according to reporting by The Times of India. The child was treated at Sahyadri Hospital, Nagar Road, Pune, where a multidisciplinary team of doctors provided prolonged intensive care that ultimately supported his recovery and discharge from the hospital.

Incident and Initial Condition

The toddler was initially brought to a local hospital following the fall, but his condition deteriorated rapidly. He was then transferred to Sahyadri Hospital, where physicians found him in critical condition. On arrival, the child was:

• Unconscious and unresponsive to pain

• Showing unequal pupil size

• Breathing shallowly

• Exhibiting dangerously low blood pressure

This prompted immediate intervention by critical care specialists.

Medical Evaluation and Diagnosis

Traumatic Brain Injury and Other Injuries

Doctors conducted diagnostic imaging, including CT and MRI scans, which revealed:

• Fractures of the parietal and temporal bones

• Bleeding within the brain

• Diffuse axonal injury, a severe form of brain trauma involving widespread damage to nerve fibers

• Rib fractures resulting in bilateral pneumothorax (air between the lungs and chest wall)

Seizure Activity

The child developed ongoing seizure activity that did not present with typical convulsions. Continuous EEG monitoring confirmed non-convulsive status epilepticus, a condition in which the brain continues seizure activity without visible physical seizures and can increase pressure inside the brain.

Treatment and Intensive Care

Ventilatory Support and Stabilisation

To support breathing and stabilize vital signs, doctors:

• Intubated the child and placed him on a ventilator

• Administered medications to stabilize blood pressure, control brain swelling, and manage seizures

Tracheostomy

Approximately 15 days after admission, a tracheostomy was performed to enable prolonged mechanical ventilation as his spontaneous breathing remained weak.

Continuous Monitoring and Care

The medical team used continuous EEG monitoring and multiple anti-seizure medications to address ongoing neurological instability. Intercostal drains were inserted to treat the bilateral pneumothorax caused by the rib fractures.

Recovery and Follow-Up

After nearly one month in intensive care, the child was weaned off the ventilator and oxygen support. Upon discharge:

• He was responsive and able to move his limbs

• He had begun to sit up independently

• Initial testing indicated normal hearing while vision continued to be observed

In a three-month follow-up, physicians reported, normal vision and hearing, age-appropriate walking and speech development.

Clinical Significance

Traumatic brain injury in young children can lead to a wide range of complications, including physical, cognitive, and developmental delays. Severe injuries such as skull fractures and diffuse axonal injury increase the risk of long-term impairments. Prompt and comprehensive critical care, including neurological monitoring, ventilatory support, and seizure management is essential for stabilisation and recovery. The use of advanced imaging and continuous EEG allows clinicians to tailor interventions and monitor progress.¹

Recovery outcomes vary widely depending on the nature of the injury, the child’s overall health, the timeliness of care, and rehabilitation support.

Reference

1. Araki T, Yokota H, Morita A. Pediatric Traumatic Brain Injury: Characteristic Features, Diagnosis, and Management. Neurol Med Chir (Tokyo). 2017 Feb 15;57(2):82-93. doi: 10.2176/nmc.ra.2016-0191. Epub 2017 Jan 20. PMID: 28111406; PMCID: PMC5341344.

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