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Chronic epidural hematomas in childhood: increased recognition and non-surgical management
E M Kaye1, P R Cass, E Dooling
1Department of Pediatrics, Boston University School of Medicine, Boston City Hospital, MA.
Insights
Non-surgical management may be effective for chronic epidural hematomas in children. Two of three children recovered fully without surgery, showing hematoma resorption and normal neurological exams.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Radiology
Background:
- Chronic intracranial epidural hematomas are rare in children.
- Computed tomographic (CT) scanning is crucial for diagnosis.
- Management strategies for pediatric epidural hematomas vary.
Observation:
- Three pediatric cases of chronic epidural hematomas diagnosed via CT scan 2-11 days post-head injury.
- Two children were managed non-surgically for one month.
- One child underwent surgical evacuation due to recurrent vomiting.
Findings:
- Non-surgically managed children remained clinically stable with no neurological deterioration.
- Follow-up CT scans showed evidence of hematoma resorption in non-surgically treated cases.
- All children, including the one who had surgery, had normal neurological examinations post-treatment.
Implications:
- Conservative, non-surgical management can be a viable option for select pediatric chronic epidural hematomas.
- Careful monitoring and serial neuroimaging are essential for non-surgical candidates.
- This approach may avoid the risks associated with neurosurgery in stable pediatric patients.
Abstract:
Three children with chronic intracranial epidural hematomas are described. The hematomas were identified by computed tomographic scanning two to eleven days after a head injury. Two of the children were managed non-surgically over a one month period, during which time they remained stable without deteriorating consciousness or development of focal neurologic signs, and with evidence of resorption of the hematomas on follow-up scans. One child, initially clinically stable, had surgical evacuation of her clot 17 days after the injury because of a recurrence of vomiting. The children with chronic epidural hematomas managed without neurosurgical intervention were normal on subsequent neurologic examinations.