Ten-year-old Joanna Ramos died from blunt force trauma after emergency surgery for a blood clot on her brain, investigators and family members said.
As far as police can tell, the blunt force did not come from a weapon, or a wall, or a windshield, but only the fists of another young girl
whom she fought hours earlier.
While the specific circumstances of Joanna's death are especially tragic and extremely unusual, medical experts said a blow in just the right spot can often prove fatal.
"This is rare, in that I've never seen it in a female, certainly not in a female adolescent," said Dr. Keith Black, a neurosurgeon at Cedars-Sinai Medical Center.
Black, who was not involved in Joanna's medical care, sees such injuries all the time among older patients and said a blow to the head from one young girl to another could "absolutely" be sufficient to cause enough trauma to lead to death.
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,
Coroner's Lt. Fred Corral said Ramos died of blunt force trauma to the head and said her death has been ruled a homicide, but he didn't immediately have further details about her injuries.
Joanna, who would have turned 11 on March 12, was unconscious by the time she arrived at the emergency room and underwent emergency surgery for a blood clot on her brain late Friday after she began vomiting and complained of a headache, her older sister, 17-year-old Vanessa Urbina, told The Associated Press.
"After surgery the doctor said she was still alive, and then a few minutes later he comes back and tells us that her heart stopped and they couldn't bring her back," Urbina said, crying as she sat on the steps of the 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 when it's completed.
School officials believe the fight occurred near the school in a 15-minute window between the time school let out and the start of Joanna's after-school program at 2:30 p.m., said Chris Eftychiou, a spokesman for the Long Beach Unified School District.
Joanna didn't have any visible injuries or show any signs of distress for about an hour, but she eventually told staff she felt unwell and was picked up by a relative, he said.
Urbina, the older sister, said Joanna's cousin picked her up. After her mother retrieved her, Joanna vomited in the car all the way home and told her mother she felt sleepy and wanted to go to bed.
Symptoms -- such as headache, nausea, lethargy -- may not set in for hours and people can mistakenly think that they're fine
, Black said.
Typically, he said, the hit to the head would have to be fairly significant to cause a blood clot and often involves the head hitting walls or the ground, but a punch is enough.
"You can certainly get enough of an impact to get enough movement in the brain by a fist to tear a vein, if it's in the right location," Black said.
Police have said the fight lasted less than a minute, did not involve weapons, and no one was knocked to the ground.
A friend of Joanna's saw her as she reported to the after-school program after the fight and said she had blood on her knuckles from wiping at a bloody nose, said Cristina Perez, the friend's mother.