A nine-year-old elementary school student injured during physical education class due to inadequate supervision by two PE instructors. Students had been instructed to use equipment that warned them to use a helmet and provided weight limitations. Both warnings were ignored. The student fell and sustained a left frontoparietal subdural hematoma that did not require surgery. After three days in the hospital, the student returned home to recuperate.
The student experienced deficits in attention-concentration, processing speed, and behavioral dysregulation. The case was complicated because the student remained in the same public school system, and it was evident that there was a coordinated effort within the school system to minimize the impact of his injuries.
Advanced neuroimaging demonstrated abnormalities in diffusion tensor imaging:
There were also abnormalities demonstrated in the volumetric assessment
While a common feature of acquired brain injury, particularly in the pediatric population, is behavioral dysregulation, it is not uncommon for the patient to maintain control in public such as in school but to experience dysregulation in more private environments including the home.