Bradycardia, headache, and vomiting in a child after a fall

A 10 year old child presented with a history of falling from a height of about 1.5 metres and landing on his face. He did not lose consciousness after the fall, but an hour later he developed headache, dizziness, and had two episodes of vomiting, when he was taken to the emergency department. He presented with a Glasgow coma scale of 15/15, stable vital signs, and a minimally swollen left eye. Ophthalmology assessment showed vertical diplopia with limitations in the upward movements of the left eye (fig 1). During the assessment, he developed nausea and vomiting, accompanied by a drop in heart rate to 44 beats/min from a baseline of 85. These symptoms resolved immediately when the ophthalmological examination was stopped. An electrocardiogram showed a heart rate of 82 with a normal sinus rhythm. A computed tomography (CT) scan of the brain showed no injuries. …