Soon after discharge, the patient returned to the emergency department. At home, she was antsy and unable to sleep. The patient was diagnosed with hydrocephalus. She was quickly admitted for surgery for ventriculoperitoneal shunt placement.

Several months later, a third surgery followed to install a titanium plate on the patient’s skull. The patient had fallen and hit her head, causing the bone to shift. The plate would provide extra protection while her bones fused back together.

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The patient has remained seizure-free since her initial surgery. She still remains on anti-epileptic medication (oxcarbazepine), but she may be able to stop taking it completely or use a lower dose of medication soon if she remains seizure-free with no overt epileptiform discharges on EEG.

The patient is doing well physically and emotionally and is enrolled in mainstream kindergarten. She has a right hemiparesis, unchanged from prior to surgery. She does have problems with attention and concentration, but otherwise, cognitive abilities are normal.

Dr Mary L. Zupanc is division chief of pediatric neurology and director of the Pediatric Comprehensive Epilepsy Program at the Children’s Hospital of Orange County and the University of California, Irvine, as well as a professor in the department of pediatrics and neurology at the University of California, Irvine.