Low pressure traumatic epidural hematoma in a child with a prior hemispherectomy: Case report

Area of Science:

• Pediatric Neurosurgery
• Traumatic Brain Injury

Background:

• A 2.5-year-old male with a history of left anatomic hemispherectomy for refractory epilepsy sustained head trauma.
• The patient presented with symptoms suggestive of acute intracranial pathology.

Observation:

• Computed tomography (CT) scan revealed a left frontal epidural hematoma at the prior craniectomy site.
• Initial conservative management with close observation was initiated.

Findings:

• The epidural hematoma volume increased significantly from 29.5 to 49.3 ml within 12 hours.
• Surgical evacuation of the hematoma was performed due to clinical deterioration.
• Intraoperative findings identified a skull fracture as the source of the hemorrhage.

Implications:

• Prompt surgical intervention is crucial for managing expanding epidural hematomas in pediatric patients with prior cranial surgery.
• Successful surgical evacuation led to the patient's return to baseline neurological function.
• This case highlights the importance of vigilant monitoring and timely surgical management in pediatric head trauma, especially in patients with altered cranial anatomy.