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Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Delayed progressive intracranial bleeding in pediatric acute epidural hemorrhage treated expectantly
Andre Marolop Pangihutan Siahaan1, Martin Susanto1, Donny Luis2
1Department of Neurosurgery, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia.
Insights
Progressive epidural hematoma (PEDH) is rare but can enlarge six days post-trauma. Young age and linear fractures are key risk factors. Prompt neurological exams are crucial for managing this condition.
Area of Science:
- Neuroscience
- Trauma Surgery
- Radiology
Background:
- Progressive epidural hematoma (PEDH) typically manifests within 24 hours of traumatic brain injury.
- Late enlargement of epidural hematoma (EDH) six days post-admission is an uncommon presentation.
Observation:
- A 14-year-old male with TBI presented with headache, initially showing a minor epidural hematoma on CT scan.
- On post-admission day 6, the patient developed severe headache, with CT revealing significant EDH enlargement and mass effect.
Findings:
- Delayed EDH progression occurred on day 6 post-trauma, a rare clinical presentation.
- The patient underwent successful emergency clot evacuation.
- Young age and linear cranial fractures were identified as risk factors for PEDH.
Implications:
- This case highlights the possibility of late-onset progressive epidural hematoma, even days after the initial injury.
- Routine neurological examinations are critical for detecting delayed intracranial hemorrhages.
- Early surgical intervention is vital for managing significant mass effect from progressive EDH.
Introduction And Importance:
Progressive epidural hematoma (PEDH) after traumatic brain injury is usually found in the first 24 h after accident. However, EDH enlargement on day six after admission is rarely observed.
Presentation Of Case:
We present the case of a 14-year-old boy who presented to the emergency room after a car accident with only a headache without any neurological deficit. The computed tomography (CT) scan revealed a slight epidural hematoma, which then treated expectantly. On day 6, the patient developed severe headache. CT-Scan showed enlarged epidural hematoma with significant mass effect. The emergency clot evacuation was completed successfully.
Clinical Discussion:
Progressive intracranial hemorrhage is any increase in pre-existing intracranial bleeding or the presence of a new hematoma on a CT scan. Young age and cranial fracture have been identified as risk factors for PEDH morbidity and mortality. Coagulation parameters may be a predictor of progressive intracranial bleeding, but their accuracy remains unclear. Still, the decision to conduct a CT scan as a follow-up is debatable, but it should be performed when neurological deterioration occurs.
Conclusion:
Although rare, PEDH could still be occurred six days after trauma. Linear fracture and young age are among the risk factors. A thorough routine neurological examination is crucial in treating this condition.
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