Clinical observation of self-injurious behavior correlated with changes in scalp morphology in a child with congenital hydrocephalus

Ellie C. Hartman, Elizabeth Gilles, Jennifer McComas, Stacy E. Danov, Frank J Symons

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

We report the case of a 12-year-old girl born with cerebral dysgenesis and congenital hydrocephalus first shunted shortly after birth. She had severe tissue-damaging self-injurious behavior, profound mental retardation, quadriparesis, as well as multiple cranial anomalies including turricephaly. After stage 1 cranial remodeling, a bone window was left pending second stage remodeling. Episodic changes in fluctuation of the scalp overlying the bone window were easily observed. During the course of a behavioral assessment for her self-injury, it was observed that the overall frequency of occurrence of self-injury increased significantly (P < .01) when the scalp was protruding and bulging compared with when the scalp was flush with the skull table. Periods of increased scalp protrusion were also associated with higher scores on a pain scale developed for children with communicative impairments associated with severe neurological impairment. After shunt replacement, there was remarkable improvement in functional status and decreased episodic self-injury.

Original languageEnglish (US)
Pages (from-to)1062-1065
Number of pages4
JournalJournal of Child Neurology
Volume23
Issue number9
DOIs
StatePublished - Sep 3 2008

Keywords

  • Functional analysis
  • Pain
  • Self-injury

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