Management of supratentorial epidural hematoma in children: report on 49 patients

Abstract

Traumatic head injury is a common cause of mortality and acquired neurological impairment in children. However, pediatric epidural hematomas (EDHs) are not common and few series have studied the evolution of these patients. In this study, we present the results from a sample of patients with EDH with long-term follow-up. Method: Between January 2006 and December 2008, 49 patients with traumatic EDH were treated at our unit. Clinical course, radiological findings and outcomes were evaluated. Neurological status was assessed using the Glasgow Coma Scale (GCS). The patients' ages ranged from one day to 16 years. The mean follow-up was six months. Results: On admission, most of the patients presented mild trauma and 57% had a GCS of 13-15. The most common symptom was irritability. The most frequent mechanisms of injury were: falling from a height in 29 cases and motor vehicle accidents in 16 cases. Three of these patients presented GCS 3, but only one died. We found a late neurological deficit in nine patients. Conclusion: These lesions may occur following mild head trauma and in alert children with nonfocal neurological examinations. However, in children presenting irritability with subgaleal hematomas and a history of loss of consciousness, skull computed tomography must be performed. Key words: epidural hematoma, head trauma, children.Tratamento de hematoma epidural supratentorial em crianças: avaliação em 49 pacientes RESUMO Trauma craniocerebral é uma causa frequente de mortalidade e comprometimento neurológico adquirido em crianças. No entanto, hematomas epidurais (HED) são raros em pacientes pediátricos, com poucas series estudando a evolução destes pacientes. Neste estudo, os autores apresentam os resultados de uma casuística de pacientes com HED acompanhados em longo prazo. Método: Entre janeiro de 2006 e dezembro de 2008, 49 pacientes com HED foram tratados em nossa unidade. Curso clínico, achados radiológicos, e resultados foram avaliados. O estado neurológico foi avaliado com o Glasgow Coma Scale (GCS). A idade variou de 1 dia a 16 anos. A média de acompanhamento foi de 6 meses. Resultados: Na admissão, a maioria dos pacientes apresentava trauma leve e 57% estavam com GCS de 13-15. O sintoma mais comum foi irritabilidade. Os mecanismos de trauma mais frequentes foram queda de altura em 29 casos e acidentes de trânsito em 16 casos. Três destes pacientes apresentavam GCS 3, mas somente um morreu. Verificou-se déficit neurológico tardio em nove pacientes. Conclusão: Esta lesão pode ocorrer após traumas leves e em crianças alerta com exames neurológicos não focais. No

Utility of Clinical and Radiographic Findings in the Management of Traumatic Epidural Hematoma

“…However, the literature is limited to relatively small retrospective case series with few studies comparing the clinical and radiographic characteristics of the observation and surgery groups. As a result, there is substantial variation in treatment practices between centers, with reported operative rates ranging from 20 to 71% [10,11,12,13,14,15]. Only one study in pediatric EDH patients has attempted to define uniform radiographic criteria to identify patients who should undergo surgery based on several clinical and CT findings [10].…”

The Surgical Outcome of Traumatic Extra-Axial Hematomas Causing Brain Herniation in Children

“…Severe head injuries may be complicated by subdural hematoma (SDH) or epidural hematoma (EDH). The incidence of SDH in children is higher than that of EDH [2,3,4]. Acute extra-axial hematomas (SDH and EDH) are among the most common clinical entities of traumatic brain injury encountered in children by neurosurgeons.…”

Acute epidural hematoma manifesting with monoplegia in a child: Case report

“…Headache and vomiting is the second most common clinical symptoms on admission [6,7]. Other signs or symptoms include lucid interval, papillary abnormalities, hemiparesis, decerebration, and seizures, heart rate, respiration and blood pressure changes (Cushing reflex) [5][6][7][8]. When talking about EDH, the term of 'lucid interval' comes to our minds.…”

“…EDH may manifest with many different clinical signs and symptoms [3]. Loss of muscle strength is seen usually as hemiparesis in this pathology [5][6][7][8]. However, monoplegia associated with EDH is very rare and literature reveals only one case that had vertex hematoma [9].…”