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Extradural haematoma in infants
J R Leggate1, N Lopez-Ramos, L Genitori
1Department of Paediatric Neurosurgery, Hôpital des Enfants, La Timone, Marseille, France.
Insights
This study analyzed 40 infants with extradural hematomas (EDH), finding falls were the most common cause. Most EDH were parietal or temporal, with middle meningeal artery bleeding being frequent.
Area of Science:
- Pediatric Neurosurgery
- Trauma Surgery
- Pediatric Neurology
Background:
- Extradural hematomas (EDH) are a significant cause of pediatric head injury.
- Understanding the clinical and operative characteristics of EDH in infants is crucial for effective management.
- This study reviews a historical cohort of infants treated for EDH.
Purpose of the Study:
- To present the clinical and operative findings of 40 infants treated for EDH.
- To analyze the causes, symptoms, locations, and outcomes of EDH in this pediatric population.
- To compare findings across different age groups within infancy.
Main Methods:
- Retrospective review of 40 infants treated for EDH between 1960 and 1988.
- Categorization of infants into three age groups: <6 months, 7-12 months, and 13-24 months.
- Analysis of etiological factors, clinical presentation, radiological findings, surgical sources of bleeding, and patient outcomes.
Main Results:
- Falls (less than 1m or greater than 1m) were the most common cause (70%).
- Drowsiness (60%) and delayed vomiting (45%) were key symptoms; 47.5% presented with anemia.
- Parietal, temporal, or temporo-parietal locations predominated (75%); middle meningeal artery was the most frequent bleeding source (42.5%).
- Mortality was 12.5% and morbidity was 15%, including motor deficits and epilepsy.
Conclusions:
- Infantile EDH, often caused by falls, presents with specific clinical and radiological features.
- Prompt diagnosis and surgical intervention are vital for improving outcomes in pediatric EDH.
- The findings highlight the importance of considering EDH in infants with head trauma, even with seemingly minor mechanisms of injury.
Abstract:
The clinical and operative findings of 40 infants treated for Extradural Haematomas (EDH) between 1960 and 1988 are presented. This series represents 19% of the total number of children with EDH during this period. Twenty-five (63%) were male, fifteen (37%) female. They were divided into three groups according to age for comparison. Group A, less than 6 months (11 cases); group B, 7-12 months (16 cases); and group C, 13-24 months (13 cases). Sixteen (40%) resulted from falls less than 1 m. Seven (17.5%) fell whilst walking. Twelve (30%) fell more than 1 m. Two EDH followed obstetric trauma, three occurred as a result of a road traffic accident. A lucid interval was identified in 30 cases, and in 15 it was longer than 24 h. Drowsiness (60%), and delayed vomiting (45%), were the most important symptoms. Anaemia occurred in 19 (47.5%). Thirty-six (90%) had abnormal skull X-rays. Thirty (75%) EDH were parietal, temporal, or temporo-parietal. Two were located in the posterior fossa. There were no frontal EDH in this series in contrast to that found in older children. Twenty-seven (67.5%) EDH were larger than 75 cc in volume. The source of bleeding was identified in 31; in 17 (42.5%) it was from the middle meningeal artery; in 11 (27.5%) from the bone; and in three (7.5%) from the dural surface. The mortality was 12.5% with a 15% morbidity rate, three infants (7.5%), suffering motor deficits, and three requiring medical treatment for epilepsy.