title: Clinical observation of self-injurious behavior correlated with changes in scalp morphology in a child with congenital hydrocephalus.
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.
authors.affiliation: University of Minnesota, Minneapolis, MN 55455, USA.
authors.forename: Ellie C
authors.initials: EC
authors.lastname: Hartman
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Gilles
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: McComas
authors.forename: Stacy E
authors.initials: SE
authors.lastname: Danov
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Symons
mesh_terms: D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects / Q000379:methods; D002648:Child; D019465:Craniofacial Abnormalities / Q000601:surgery*; D003399:Craniotomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008607:Intellectual Disability / Q000209:etiology; D019586:Intracranial Hypertension / Q000150:complications / Q000601:surgery; D054220:Malformations of Cortical Development / Q000150:complications; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D059408:Pain Management; D010147:Pain Measurement; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D011782:Quadriplegia / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D012086:Reoperation / Q000379:methods; D012535:Scalp / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016728:Self-Injurious Behavior / Q000209:etiology* / Q000628:therapy; D012886:Skull / Q000002:abnormalities / Q000601:surgery; D016896:Treatment Outcome