Boy's death after being hit in the head at a school on the coast of SP raises awareness of signs of brain trauma

Why can a blow to the head get worse hours later? In the temple region of the brain, some arteries supply the meninges, which is like a protective skin around the brain. The middle meningeal artery is right under the bone, for example. When trauma occurs in the temporal region, these arteries can rupture. The person may lose consciousness for a while and then return to normal, but bleeding may continue to occur. The boy seemed to be fine and went to class. This is called a lucid interval in the medical literature. The person has a trauma, talks to the doctor consciously, doesn't have a headache, and then goes into a coma. "This occurs because the bleeding occurs in a very gradual and small way, but there comes a time when the brain can no longer compensate. There is nowhere for the cerebral pressure that pushes the brain to the side to go. This is what we call cerebral herniation. Part of the brain goes downwards and compresses some cerebral arteries", explains Martins. The doctor highlights that, after brain trauma, it is always important for the patient to remain under observation for 24 hours and not sleep afterwards. What warning signs require immediate attention? To avoid complications from possible brain hemorrhages, it is necessary to observe some signs, such as: Excessive drowsiness Confusion Loss of consciousness, even if brief Vomiting Headache Difficulty speaking Weakness Inconsolable crying If the patient has any of these signs, a tomography may be requested to evaluate a possible hematoma, which could be surgical. Martins explains that tomography scans are not carried out in Basic Health Units, nor in Emergency Care Units (UPAs), but these generally refer the patient to hospitals where the examination is carried out. Sometimes the bruises grow so quickly that even in the hospital it can be difficult to save the patient. Once the hematoma is identified with the tomography, a fight against time begins to begin surgery and stop the internal bleeding. Martins adds that in every death there is cardiorespiratory arrest and this is not the cause of death. Respiratory failure is only the final common route of any complication, such as pneumonia, pulmonary embolism, systemic infection or brain injury, for example. “The cause of death was probably trauma, because the coroner reported that there was a cerebral hemorrhage and a major cerebral infarction,” says Martins. The neurologist adds that severe brain trauma in children is more common in situations of falling from a height. Understand the case According to the family, Bernardo was a healthy child, with no history of health problems or allergies to medications. After being hit by a ball during a physical activity at school, he returned to the classroom, where he fell ill. He then fell and hit his head "on the floor or on his desk." The teacher was not in the room at the time, and the students themselves informed the staff, who called Samu. Before help arrived, an employee who had previously been a firefighter tried to revive the boy. Afterwards, an employee took him by car to the Bertioguense Medical Specialties Unit (Unibem), as it was the closest health service. The family questions the care provided at the unit and claims that an error during intubation would have impaired Bernardo's breathing and worsened his condition. Subsequently, Samu took over the incident and transferred him to Bertioga Hospital, where death was confirmed after around 40 minutes of resuscitation attempts. Relatives also requested access to images from the school to clarify how the fall occurred. A preliminary examination by the Legal Medical Institute (IML) showed that Bernardo had an "aneurysm in the head", which developed into a heart attack, while the death certificate recorded "respiratory failure" as the cause of death. Additional exams are still ongoing. In a statement, the City of Bertioga reported that the boy received immediate care at Unibem, with the start of emergency and resuscitation protocols before transfer to the hospital, lamented the death and offered solidarity to the family, but did not respond to the question about the report of a failure in medical care. Bertioga Municipal Hospital, SP Renato Inácio