Hemophilia and child abuse as possible causes of epidural hematoma: case report

Abstract

INTRODUCTION: Head trauma is an important consequence of child abuse. Specific pathophysiological mechanisms in child abuse are responsible for the ''whiplash shaken-baby syndrome'', which would favour the occurrence of intracranial hemorrhages. CASE REPORT: We report the case of a child who developed epidural hematoma following minor-intensity head trauma. Initial diagnosis of child abuse was made, but subsequent investigation led to the diagnosis of hemophilia A. CONCLUSION: Even though epidural hematoma is not closely associated with child abuse, this aethiology must always be considered when the reported trauma mechanism is out of proportion to the magnitude of the encountered lesions.

Clinical approach in children with suspected physical abuse

“…In the differential diagnosis, intracranial hemorrhages occurring during delivery (NB asymptomatic, recovers in 4 weeks), genetic and metabolic diseases (Osteogenesis imperfecta and Menkes Kinky hair glutaric aciduria Type 1), hemorrhagic diathesis (prothrombin time, partial thromboplastin time, bleeding time, complete blood count, platelet count, fibrinogen, and fibrin degradation products), vascular malformations, diseases leading to increased intracranial pressure, electrolyte imbalances, and intracranial infections should be considered. A shaken baby syndrome is preventable and it is especially important to inform the parents who have risk factors about child development stages, stress management, and the particulars of caregiving (9,(10)(11)(12)(13)(14)(15). In suspected cases, typical retinal hemorrhage is found.…”

“…In suspected cases, typical retinal hemorrhage is found. Therefore, a detailed fundoscopic examination helps make the diagnosis (11)(12)(13)(14)(15).…”

“…Especially, careful and detailed interviews should be performed with individuals who are obliged to look after the child. The child's growth and development, medical and social history, sibling history and if any sibling died or has any disease, should be interrogated and other causes such as accidents leading to injury, metabolic disorders and diseases should be eliminated (13)(14)(15). The contradiction between present lesions and history is a warning sign.…”

“…The contradiction between present lesions and history is a warning sign. It is frequently informed that the child has been injured as a result of an accident or by their peers/siblings at the time of presentation at the healthcare center, and there are discrepancies between the histories obtained from family members (11)(12)(13)(14)(15)(16). The history given and the child's developmental stage should be primarily compared, and history should be obtained from the child himself/herself in a safe environment as well as obtaining a history from family members separately.…”

“…The physical examination findings vary depending on the type and severity of trauma. Therefore, a complete physical examination should be performed (13)(14)(15). For example, detailed skin examination should be performed in addition to multisystem evaluation by removing the child's underclothes, diaper and socks in a 2-month-old child who presents with fever and is found to have ecchymoses with different shapes and dimensions or who presents with closed consciousness and a history of falling from the armchair.…”