Traumatic pediatric bear injury resulting in cerebrospinal fluid leakage

Area of Science:

• Trauma surgery
• Pediatric neurosurgery
• Wildlife-related injuries

Background:

• Cerebrospinal fluid (CSF) leakage is a recognized complication of traumatic brain injuries, particularly open skull fractures in children.
• Black bear encounters, though infrequent, can lead to severe injuries in pediatric populations.
• Northeast Pennsylvania has a notable black bear population, increasing the potential for human-wildlife interactions.

Observation:

• A 15-month-old male presented with a skull base wound after a traumatic bear mauling.
• The wound was leaking clear fluid, raising suspicion for cerebrospinal fluid (CSF) leakage.
• The patient was treated as a level 1 trauma alert due to the severity of the injury.

Findings:

• The pediatric patient sustained a traumatic skull injury with associated cerebrospinal fluid (CSF) leakage.
• Despite the severity of the injury, the CSF leak demonstrated spontaneous resolution without the need for surgical intervention.
• This case underscores the potential for significant traumatic injuries, including CSF leaks, from bear maulings in children.

Implications:

• This case highlights a rare but plausible mechanism for traumatic CSF leaks in pediatric patients resulting from animal attacks.
• It emphasizes the importance of considering wildlife encounters in the differential diagnosis of pediatric head trauma, especially in endemic regions.
• The spontaneous resolution observed suggests that conservative management may be appropriate for certain traumatic CSF leaks in pediatric populations, even those resulting from severe trauma.