LONG BEACH, California (AP) - What started as an after-school fight between two young girls over a boy turned into a homicide investigation Monday, when authorities said a 10-year-old died of a head injury after the confrontation.
Blunt force trauma killed Joanna Ramos, who collapsed at home after Friday's fight, coroner's Lt. Fred Corral said.
The girl's older sister said Joanna died after surgery for a blood clot on the brain hours after the fight in an alley with an 11-year-old girl. Joanna had started vomiting and complained of a headache and was unconscious by the time she arrived at the emergency room, said Vanessa Urbina, 17, crying as she sat on the steps of Willard Elementary School near a memorial of flowers and balloons.
Police said they have made no arrests and were conducting an investigation that will be presented to prosecutors.
Punches to the head can often lead to delayed bleeding if a vein is torn, and that can lead to a clot when blood collects on the surface of the brain, said Dr. Keith Black, a neurosurgeon at Cedars-Sinai Medical Center.
"This is rare, in that I've never seen it in a female, certainly not in a female adolescent," said Black, who was not involved in Joanna's medical care.
Symptoms - such as headache, nausea, lethargy - may not set in for hours and people can mistakenly think that they're fine.
"Just because you're OK immediately after a head injury, you still need to be very concerned" about pressure buildup in the brain that can be life-threatening, Black said.
He said a blow to the head from one young girl to another could "absolutely" be sufficient to cause enough trauma to lead to death.
Friday's fight lasted less than a minute, police said. It didn't involve weapons, and no one was knocked to the ground.
"They took off their backpacks, and they put their hair in a bun, and then that's when they said 'Go' and that's when they started hitting each other," Joanna's friend and classmate Maggie Martinez, who watched the fight, told KNBC.
Martinez and other friends said they tried to stop the fight but were held back by boys who were watching and wanted it to continue.
School officials believe the fight occurred in a 15-minute window between the time school ended and the start of Joanna's after-school program, said Chris Eftychiou, a spokesman for the Long Beach Unified School District.
Mothers said their children told them the fight was over a boy.
Fights involving young children are increasing in the U.S., in part because social media and text messaging mean students can continue their dispute 24 hours a day, said Travis Brown, a national expert on bullying and school violence.
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