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Spontaneous rapid resolution of acute subdural hematoma in children
Ahmet Öğrenci1, Murat Şakir Ekşi2, Orkun Koban3
1Department of Neurosurgery, Batman State Hospital, Batman, Turkey.
Insights
Spontaneous resolution of pediatric acute subdural hematoma (ASH) is rare but possible. Conservative management may be effective for stable pediatric ASH cases, avoiding surgery.
Area of Science:
- Pediatric Neurosurgery
- Trauma Management
- Neurology
Background:
- Acute subdural hematoma (ASH) in children following trauma is uncommon.
- Spontaneous rapid resolution of pediatric ASH is exceptionally rare.
- This review analyzes mechanisms, characteristics, and outcomes of pediatric ASH with spontaneous resolution.
Observation:
- A 3-year-old boy with mild head trauma presented with acute subdural hematoma and significant midline shift.
- Despite initial findings, conservative management was chosen due to the patient's stable neurological status.
- Follow-up CT scans showed dramatic regression of the hematoma and midline shift within hours.
Findings:
- Analysis of 12 pediatric cases revealed a mean age of 6.87 years.
- Causes of ASH included falls, accidents, and child abuse.
- Conservative treatment with close follow-up is recommended for stable pediatric ASH patients.
Implications:
- Conservative management can be successful in select pediatric acute subdural hematoma cases.
- Prompt surgical intervention is crucial if neurological status deteriorates.
- Understanding spontaneous resolution aids in optimizing treatment strategies for pediatric head trauma.
Background:
Spontaneous rapid resolution of acute subdural hematoma developing secondary to trauma has been reported in the literature, yet it is very rare in pediatric population. The aim of the present review is to analyze mechanisms, characteristics, and outcomes of pediatric acute subdural hematoma cases with spontaneous rapid resolution in conjunction with an exemplary case of ours.
Case Description:
A 3-year-old boy was admitted to our emergency department following mild head trauma secondary to a fall from 2 m. He was alert and has a GCS of 15. He had no motor or sensorial deficit on neurological examination. On the emergent brain computed tomography image, an acute subdural hematoma over left frontoparietal lobe was observed. There was a midline shift of 8.3 mm and the width of the hematoma at the thickest portion was 11.2 mm. Surgery was postponed with a close neurological follow-up of the patient in pediatric intensive care unit, due to his well neurological status without any increased ICP findings. On the fourth hour follow-up head CT image, amount of midline shift and hematoma thickness were observed to have regressed dramatically. At the second week, the hematoma resorbed totally with only conservative approach, and he was discharged to home in well status.
Discussion And Conclusion:
Analysis of 12 pediatric patients revealed a mean and median ages of 6.87 and 3.9 years, respectively (range = 8 months-18 years). Causes for ASH development were fall, traffic accident, struggle, and child abuse. Main clinical presentations were with depressed sensorium, coma, stupor, drowsiness, headache, motor weakness, lethargy, and seizure. Close follow-up with conservative treatment should be mode of approach in pediatric patients with ASH, if neurological and radiological findings are favorable. However, if patients' neurological status deteriorates after admission to hospital, surgery should be conveyed with no further delay.
