The Story of Tommy's Big Head

Kalvin and Leah Greuel of Hawley, Minnesota, adopted Tommy soon after he was born to a woman that Leah met at Walmart. That in itself is a story, but then Tommy suffered from a mysterious condition that caused his head to grow too fast.
At 6 months old, it was off the charts for his age group. At 9 months, it was nearly the size of a 5-year-old’s. No one they consulted had seen anything like it. The Greuels started looking for specialists and for answers.

On June 26, 2010, before they found the latter, Tommy had a seizure that lasted more than six minutes. Leah took him to the emergency room, where tests showed bleeding in the brain, hemorrhages in both eyes and a fluid build-up in his skull.

They were symptoms of Tommy’s condition, exacerbated by everyday bumps and stumbles. His connective tissue was weak, particularly around his eyes, and his brain was bruised from bumping into the inside of his own skull.

The Greuels didn’t know that yet. Neither did the hospital staff, who instead saw his symptoms as telltale signs of something else: shaken baby syndrome.

The hospital called Clay County Social Services, which said the injuries were evidence of child abuse – and that Kaylee was in danger as well.

And one day in early July, the agency took both children away.

The story continues with the Greuel's struggle to get their children back, and an even bigger struggle to get medical help for Tommy while the state had custody. See, the social service agency didn't think Tommy needed to keep his appointments with specialists because they already knew that the problem was shaken baby syndrome. Read the entire story so far at InForum. Link to part one. Link to part two (with video). -via Minnesota Public Radio

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Child Services must have suspected Hydrocephalus and ordered the peritoneal shunt. While reading, my provisional diagnosis was lesion of the mid-brain obstructing the lateral ventricles and Ascending Reticular Activating System (ARAS). According to Human Malformations And Related Anomalies By Roger E. Stevenson, Judith G. Hall, Macrocephaly may be accompanied by Hydrocephaly but it's the subarachnoid space that is enlarged. The peritoneal shunt probably would have been a permanent mistake.
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"Shaken Baby Syndrome" is a misnomer. The actual condition is called "arterial shearing" and results from a "rapid deceleration" of the brain. This can happen in a car accident, kid falling over, anything that rapidly decelerates the brain will cause it to slosh about in an over-sized skull. The cerebral hemispheres are separated by the interhemispheric fissure which is occupied by the falx cerebri - a hardened portion of the dura mater which projects into the interhemispheric fissure. When the brain rotates inside the enlarged skull the cerebral hemispheres butt up against the falx cerebri and can be distorted causing "axonal shearing" of the connective tissue that binds the two hemispheres; the corpus callosum (probably the anterior commissure as well). Axonal shearing can cause cognitive and behavioral problems that are not detectable on any brain image (e.g. CT, MRI, SPECT, etc..) Hemmorhaging in infants with "Shaken Baby Syndrome" is typically localizable to the Medial Cerebral Artery which affects the precentral gyrus containing the primary motor cortex, but can also affect the somatosensory cortex posterior of the central sulcus of Rolando in the postcentral gyrus.
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BTW; Axonal and Arterial shearing can happen to anyone at any age. They are the bulk of Traumatic Brain Injuries (TBIs) experienced by Military Personnel, Football Players and Boxers. Infants and the elderly are especially at risk due to having a skull vault larger than the brain (The brain shrinks with age). With Axonal Shearing; cells called Schwann cells congregate around the damaged axon and assist in a process known as Wallerian Degeneration. You may recall in February of last year, Dave Duerson, an NFL football player, suffered severe TBIs with accompanying degeneration and subsequently took his own life. He shot himself in the stomach and donated his brain to the study of sports related TBIs.
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