Abstract:AIm: We present our experiences in the management of extradural haematoma in children which involved an aggressive diagnostic approach, prompt surgical evacuation results in an excellent outcome. mAterIAl and methOds: 170 EDH patients who underwent surgery in our department from January 2006 to July 2010 included in this prospective study. Each patient evaluated in term of age, sex, mode of injury, localization of haematoma, clinical presentation, CT findings, operative measures and outcome.results: Out of 170… Show more
“…The incidence of EDH has been reported between 1% and 6% of hospitalized patients following a traumatic brain injury. [581424] Children with EDH are less likely to lose consciousness from the traumatic event and require immediate surgery less frequently. They also show a lower incidence of intradural hematomas compared with adults.…”
Background:Children with epidural hematoma (EDH) present differently than adults. The outcome of treatment is also different. We aim to report our experiences with EDH in pediatric age group in terms of mode of injury, presenting features, management, and outcomes. We also aim to identify different prognostic indicators in pediatric patients with EDH.Methods:We prospectively collected data from 24 consecutively surgically treated pediatric patients. The data collected included presenting features, radiological imaging, details of management, and outcomes. Descriptive analysis was performed and different variables were tested for any statistical significance with Glasgow Outcome Score (GOS).Results:There were 19 male and 5 female patients. The mean Glasgow Coma Scale (GCS) score at presentation was 9.3 ± 4.4. Falls were the most common cause of EDH. Outcome assessment was done at 3 month follow up. A total of 15 patients had a GOS score of 5, 4 patients had a GOS score of 4, 2 patients had a GOS score of 3, while 3 patients had a GOS score of 1. On univariate analysis, admitting GCS score, patient's age, the time from injury to admission and injury to surgery, anisocoric pupils at presentation and effacement of basal cisterns were significantly associated with the outcome of GOS score.Conclusion:Falls are the most common mode of injury leading to EDH in children. Lower GCS at presentation, younger age at trauma, increased time since trauma to surgery and admission, anisocoria and effacement of basal cisterns are statistically significant variables in surgically treated pediatric patients of EDH that confer a poorer prognosis. A timely surgical intervention can result in excellent outcomes.
“…The incidence of EDH has been reported between 1% and 6% of hospitalized patients following a traumatic brain injury. [581424] Children with EDH are less likely to lose consciousness from the traumatic event and require immediate surgery less frequently. They also show a lower incidence of intradural hematomas compared with adults.…”
Background:Children with epidural hematoma (EDH) present differently than adults. The outcome of treatment is also different. We aim to report our experiences with EDH in pediatric age group in terms of mode of injury, presenting features, management, and outcomes. We also aim to identify different prognostic indicators in pediatric patients with EDH.Methods:We prospectively collected data from 24 consecutively surgically treated pediatric patients. The data collected included presenting features, radiological imaging, details of management, and outcomes. Descriptive analysis was performed and different variables were tested for any statistical significance with Glasgow Outcome Score (GOS).Results:There were 19 male and 5 female patients. The mean Glasgow Coma Scale (GCS) score at presentation was 9.3 ± 4.4. Falls were the most common cause of EDH. Outcome assessment was done at 3 month follow up. A total of 15 patients had a GOS score of 5, 4 patients had a GOS score of 4, 2 patients had a GOS score of 3, while 3 patients had a GOS score of 1. On univariate analysis, admitting GCS score, patient's age, the time from injury to admission and injury to surgery, anisocoric pupils at presentation and effacement of basal cisterns were significantly associated with the outcome of GOS score.Conclusion:Falls are the most common mode of injury leading to EDH in children. Lower GCS at presentation, younger age at trauma, increased time since trauma to surgery and admission, anisocoria and effacement of basal cisterns are statistically significant variables in surgically treated pediatric patients of EDH that confer a poorer prognosis. A timely surgical intervention can result in excellent outcomes.
“…Out of many factors affecting the outcome, the most important one is the duration of time between accident and surgery; mortality can be close to 0% if this time interval can be minimized. Chowdhury et al 23 stated that EDH is one of the most rewarding neurosurgical emergencies. It must be diagnosed in the early period of the trauma and evacuated early to prevent potential mortality and morbidity.…”
Introduction: Trauma is the most common worldwide cause of death and disability in young adults. Neurotrauma is one of the most frequent indications for emergent neuroimaging because imaging plays such a key role in patient triage and management.
“…Most of the patients having EDH manifest with altered sensorium. 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].…”
Section: Discussionmentioning
confidence: 99%
“…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].…”
ÖZETYedi yaşında kız çocuğu yaklaşık iki metrelik yüksekten düşme sonrası sol bacakta ağrısız kuvvet kaybı ile baş-vurdu. Hastanın beyin tomografisinde sağ fronto-paryetal bölgede epidural hematom tespit edildi. Hematom acilen yapılan kraniyotomi ile boşaltıldı. Hasta yaklaşık iki haftalık takip sonrası çok az kuvvet kaybı ile taburcu edildi. Fronto-paryetal yerleşimli epidural hematomlar monopleji ile de belirti verebilirler ve erken cerrahi sağaltım bu hematomlara yaklaşımda standart tedavi olmalıdır.
Anahtar kelimeler: Epidural hematom, monopleji, bilgisayarlı tomografi
ABSTRACTA seven year-old girl presented with left sided painless monoplegia at the lower extremity after falling from two meters height. Cranial computed tomography showed right sided fronto-parietal epidural hematoma. Urgent decompressive craniotomy for the evacuation of the hematoma was performed. Patient discharged two weeks after admission with minimal loss of muscle strength. Fronto-parietal epidural hematomas may also manifest with monoplegia and early evacuation should be standard management. J Clin Exp Invest 2013; 4 (2): 223-225
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