Delayed posttraumatic unilateral occipital epidural hygroma in early childhood
Ivo I Kehayov1, Ivan V Batakliev, Borislav D Kitov
1Department of Neurosurgery, Medical University, Plovdiv, Bulgaria.
Insights
This report details an extremely rare case of posttraumatic epidural hygroma in a child following an occipital head injury. Early diagnosis and surgical intervention are crucial for managing this rare condition.
Area of Science:
- Neurosurgery
- Pediatric Traumatology
- Neuroradiology
Background:
- Posttraumatic epidural hygromas are rare collections of cerebrospinal fluid in the epidural space following head trauma.
- They can lead to increased intracranial pressure and neurological deficits, particularly in pediatric patients.
- Prompt diagnosis and management are essential to prevent severe outcomes.
Observation:
- A rare case of posttraumatic epidural hygroma in a 1.5-year-old child with an occipital bone fracture is presented.
- Initial CT scan showed a fracture without immediate brain injury, but delayed symptoms of intracranial hypertension emerged.
- A follow-up CT scan revealed a newly formed epidural hygroma in the supratentorial and infratentorial occipital region.
Findings:
- The case highlights the potential for delayed development of epidural hygromas after seemingly minor head trauma.
- Emphasis is placed on the mechanism of hygroma formation and predisposing factors in traumatic brain injury.
- Computed tomography follow-up is crucial for diagnosing delayed posttraumatic hygromas.
Implications:
- This case underscores the importance of vigilant monitoring and follow-up imaging in pediatric head trauma.
- Surgical management involving craniotomy and dural elevation is recommended for effective treatment.
- Understanding hygroma formation aids in refining treatment strategies for traumatic brain injuries.
Abstract:
An extremely rare case of posttraumatic epidural hygroma in the left occipital supratentorial and infratentorial region is reported. A year and five months old child was admitted to the Clinic of Neurosurgery with sustained occipital head injury. She presented with drowsiness and vomiting due to intracranial hypertension. Initial computed tomography scan revealed left-sided fracture of the squamous part of the occipital bone without associated traumatic changes to the brain. A second spiral computed tomography scan was obtained two days later because of persisting symptoms of increased intracranial pressure. It demonstrated a newly formed left-sided epidural hygroma adjacent to the skull fracture in the left supratentorial and infratentorial occipital region. The case is discussed with emphasis on the mechanism of formation of epidural hygroma and an attempt has been made to outline the major predisposing factors leading to the development of this traumatic disease. Necessity for computed tomography follow-up is pointed out in order to diagnose delayed posttraumatic hygromas. The recommended surgical approach should include craniotomy centered at the site of the epidural hygroma and obligatory dural elevation by means of traction sutures to eliminate the posttraumatic epidural cavity.
