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Complete early regression of asymptomatic hindbrain herniation caused by minor head trauma

Christina Ble1, Parmenion P Tsitsopoulos1, Maria Sidiropoulou2

  • 1Department of Neurosurgery, Hippokratio General Hospital, Aristotle University of Thessaloniki School of Health Sciences, Faculty of Medicine, Konstantinoupoleos 49, Thessaloniki, Greece.

Oxford Medical Case Reports
|March 6, 2019
PubMed

Insights

Minor head trauma in an infant caused cerebellar tonsillar herniation, a rare condition. Fortunately, the herniation resolved completely with no lasting neurological deficits observed.

Area of Science:

  • Neurology
  • Pediatric Traumatology
  • Radiology

Background:

  • Cerebellar tonsillar herniation secondary to head trauma is exceptionally rare.
  • Pediatric head injuries can present with varied and sometimes subtle neurological sequelae.

Observation:

  • An 11-month-old girl experienced minor head trauma.
  • Initial CT scan revealed an occipital bone fracture and intraventricular hemorrhage.
  • Subsequent MRI demonstrated cerebellar edema and tonsillar herniation 6 mm below the foramen magnum.

Findings:

  • The patient exhibited no neurological deficits despite the herniation.
  • Follow-up MRI at 1 month showed complete resolution of the cerebellar tonsillar herniation.
  • No posterior fossa symptoms or signs were observed during hospitalization or follow-up.

Implications:

  • This case highlights the potential for spontaneous resolution of traumatic cerebellar tonsillar herniation in infants.
  • It underscores the importance of advanced neuroimaging in evaluating pediatric head trauma.
  • The findings suggest that conservative management may be successful in select cases of pediatric traumatic hindbrain herniation.

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