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[Rapid spontaneous resolution of acute epidural hematoma in an infant:a case report]
Yukitomo Ishi1, Katsuyuki Asaoka, Taku Sugiyama
1Department of Neurosurgery, Teine Keijinkai Hospital.
Insights
This study reports a rare case of infantile acute epidural hematoma (AEDH) that rapidly resolved within 24 hours. This rapid decrease in AEDH may be linked to transmigration into the epicranial layer.
Area of Science:
- Pediatric Neurosurgery
- Neuroradiology
Background:
- Acute epidural hematoma (AEDH) typically requires weeks for resolution.
- Infantile head injuries present unique diagnostic and management challenges.
Observation:
- A 7-month-old boy sustained a head injury with a skull fracture and initial small AEDH.
- The AEDH showed rapid growth on CT scans within hours of the initial injury.
Findings:
- Conservative management was initiated due to the absence of neurological deficits.
- CT scans at 24 hours revealed significant AEDH reduction and increased subcutaneous hematoma.
- The AEDH did not enlarge on follow-up, and the patient recovered fully.
Implications:
- Rapid AEDH resolution in infants may occur via transmigration through fracture gaps.
- This case highlights the potential for non-surgical management in select pediatric AEDH cases.
- Understanding hematoma dynamics is crucial for optimizing treatment strategies in pediatric head trauma.
Abstract:
Resolution of acute epidural hematoma (AEDH) usually takes several weeks. The authors present an infantile case of AEDH that rapidly decreased within a day and review the literature. A 7-month-old boy fell from a height of approximately one meter and sustained a head injury. On presentation, a skull fracture in the right temporoparietal region was found and a small AEDH was observed on computed tomography (CT) 1 hr after the injury. He was transferred to our institute because of growing AEDH, shown by CT images taken 3 hr after the injury. We decided to treat him conservatively as he did not exhibit any neurological deficits on admission. CT images 24hr after the injury showed significant reduction of the AEDH. There was also an increase in the subcutaneous hematoma. Follow-up CT images did not show enlargement of the AEDH. The patient was discharged with no neurological deficits 3 days after admission. Rapid resolution of the AEDH might have been due to transmigration of the hematoma into the epicranial layer through the fracture gap.
