Head injuries are common among active children. Joanna Ramos, 10, was struck in a fist fight with an 11-year-old girl and died six hours later. It's a rare death case, according to child neurologist Perry Lubens, but it happens.
"It depends on if her head turned in one direction or went forward and backwards. Some biomechanical force lacerated an artery inside her skull," Lubens said.
Ramos' symptoms after the fight, like vomiting, are classic signs of a concussion. But according to Lubens, vomiting and headaches alone are not reasons for alarm.
What was significant, according to Lubens, and what every parent should recognize as a danger sign, is lethargy. Ramos told her mother that she felt tired and wanted to lay down.
"That suggests that there is some kind of swelling going on inside the skull, compressing the brain, compressing the brain stem, and that is dangerous, that is potentially lethal," Lubens said.
There is no space in the skull for the brain when it swells. It pushes the brain stem, and critical functions, such as breathing, are cut off. When a child gets tired and very sleepy after a hit on the head, it's time to head to the hospital.
Lubens said Ramos might have been saved had someone known the tell-tale symptom.
"This is a treatable condition. Hemorrhages inside the brain are treatable ... but you don't have a long time," Lubens said.
Ramos' death is being investigated as a homicide, but investigators will look at multiple factors before the district attorney's office decides whether to press charges against the 11-year-old girl involved in the fight.