Extradural haematoma in children. Primary and secondary lucid intervals

Twenty-six cases of extradural haematoma in children were reviewed over a 10-year period. The incidence of extradural haematoma was 3.3/1000 patients admitted to hospital with head injuries. Of 26 patients, 23% had no skull fracture and, in a further 8%, the fracture was not radiographically detectable. Twenty-three per cent of patients showed papilloedema, and 50% exhibited a fixed dilated ipsilateral pupil. In 62% of patients, there was no initial loss of consciousness; in a further 19%, impairment of consciousness was brief or doubtful. The lucid interval lasted three hours or less in one-third of patients; 24 hours after injury, the level of consciousness had declined in 73% of patients. Of particular interest was the occurrence of a secondary lucid interval, definite and dramatic in 8% of patients, and definite, but slight, in a further 12%. All patients made a good recovery, except one, who died from massive pulmonary fat embolism.