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Cerebral ischemia: a frequent complication of large traumatic epidural hematoma in infants
Matthieu Landart1,2, Sandro Benichi1,2, Lelio Guida1,2
1Departments of1Neurosurgery.
Insights
Infants with epidural hematoma (EDH) face a high risk of cerebral ischemia and neurological deficits, despite low mortality. Early neurological deficits and low fibrinogen levels predict poor outcomes in these pediatric patients.
Area of Science:
- Pediatric Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Epidural hematoma (EDH) is rarely studied in infants.
- Understanding infant EDH outcomes is crucial for early intervention.
Purpose of the Study:
- To investigate the outcomes of infants (< 18 months) with EDH.
- To identify factors predicting radiological and clinical outcomes in infant EDH.
Main Methods:
- Retrospective single-center study of 48 infants (< 18 months) with supratentorial EDH.
- Analysis of clinical, radiological, and biological variables.
- Multivariate logistic regression to identify predictive factors.
Main Results:
- 36% of patients experienced postoperative cerebral ischemia.
- Initial neurological deficit, low platelet count, low fibrinogen, and prolonged intubation were associated with ischemia.
- Cerebral ischemia on MRI predicted poor clinical outcomes.
Conclusions:
- Infants with EDH have low mortality but high rates of cerebral ischemia.
- Long-term neurological sequelae are common in this population.
- Prompt identification of predictive factors is essential for improved management.
Objective:
Epidural hematoma (EDH) has rarely been studied specifically in infants. The objective of this study was to investigate the outcomes of patients aged < 18 months (infants) with EDH.
Methods:
The authors conducted a single-center retrospective study of 48 infants aged less than 18 months who underwent an operation for a supratentorial EDH in the last decade. Clinical, radiological, and biological variables were used in a statistical analysis to identify factors predictive of radiological and clinical outcome.
Results:
Forty-seven patients were included in the final analysis. Seventeen children (36%) had cerebral ischemia on postoperative imaging, either due to stroke (cerebral herniation) or by local compression. Factors associated with ischemia after multivariate logistic regression were the presence of an initial neurological deficit (76% vs 27%, p = 0.03), low platelet count (mean 192 vs 267 per mm3, p = 0.01), low fibrinogen level (mean 1.4 vs 2.2 g/L, p = 0.04) and long intubation time (mean 65.7 vs 10.1 hours, p = 0.03). Cerebral ischemia on MRI was predictive of a poor clinical outcome.
Conclusions:
Infants with EDH have a low mortality rate but a high risk of cerebral ischemia, along with long-term neurological sequelae.
