An 8 Year Old With Severe Sight Impairment Secondary To A Fall From A Kick Scooter

Traumatic brain injury (TBI) in the paediatric population can lead to long-term neurological morbidity and may result in substantial visual impairment.

We report the case of an 8-year-old boy who fell from his kick scooter, hitting his occipital region on to a kerb. He was taken to A&E and neuroimaging demonstrated a left-sided subdural haematoma with associated midline shift; and he underwent an urgent surgical evacuation of the haematoma.

Since the injury, he has been wheelchair-dependent and frequently bumps into obstacles in his environment, including car wing mirrors and refuse bins. He requires hand-holding for safe mobility and finds navigation particularly challenging in crowded or visually complex settings. He has also experienced visual hallucinations confined to the area of visual field loss, consistent with Charles Bonnet syndrome. These hallucinations occurred in the absence of psychiatric illness or cognitive decline and have since shown gradual improvement. He has good memory, and ongoing engagement in sensory and cognitively stimulating activities.

The patient continues to receive multidisciplinary rehabilitation, including physiotherapy and occupational therapy. He resides with his mother and two siblings. The injury and its consequences have placed a significant emotional burden on his mother, who reports reliving the incident frequently and how she was walking towards her son’s helmet to place it on him. She has reported difficulties coping with the sudden devastating impact to the family and demands of caregiving. Educational accommodations and visual impairment support have been implemented at school to facilitate his learning and participation.

This case illustrates an unfortunate presentation of paediatric homonymous hemianopia complicated by Charles Bonnet syndrome following what would normally be perceived as a trivial fall, highlighting the need for protective headwear on any child’s vehicle. It also addresses the comprehensive, multidisciplinary management approaches that address not only the child’s medical and rehabilitative needs but also the psychological and social well-being of the family unit