A 16-year-old patient with no relevant history presented a TBI without loss of consciousness. The patient reported headaches, nausea, and dizziness. On physical examination, the patient was alert, oriented in all spheres, with reactive intermediate isochoric pupils, mobilizing 4 extremities on command, without sensory-motor deficits or gait disturbances.
A brain computed tomography (CT) without contrast was performed, displaying a "ping-pong" fracture with a diameter of 30.5 mm and depression of 9.2 mm. No intraparenchymal lesions were identified. Brain CT bone window and 3D reconstruction showed the fracture in the left parietal bone [Figures 1 and 2].
Laboratory tests were performed and showed low values of ionic and total serum calcium (4.8 mg/dL and 7.8 mg/dL, respectively). With this result, the serum parathyroid hormone (PTH) levels were analyzed, which showed a low value as well (6 mg/dL), diagnosing hypocalcemia and hypoparathyroidism. Consultation with the endocrinology service was made and the patient started on calcium carbonate and vitamin D supplements, remaining under observation in the general ward for 48 h with a favorable evolution. Due to the absence of neurological deficits, intraparenchymal lesions, large cosmetic defects, and/or symptomatic progression, conservative management was performed. Hospital discharge was granted with follow-up instructions and TBI warning signs. The patient did not attend the last control (6 months after the trauma), so the evolution of the depressed "ping pong" fracture is unknown. In the previous control (1 month after the trauma), there were no complications.