Related Experiment Videos
Extradural haematomas in children
1Department of Paediatric Neurosurgery, Red Cross War Memorial Children's Hospital.
Insights
Traumatic extradural brain hemorrhages in children often present atypically. Prompt neurosurgical intervention leads to excellent outcomes in most pediatric cases.
Area of Science:
- Pediatric Neurosurgery
- Trauma Surgery
- Pediatric Neurology
Background:
- Traumatic intracranial extradural haemorrhage (EDH) is a significant concern in pediatric head injuries.
- Understanding the unique presentation and outcomes in children is crucial for timely management.
Purpose of the Study:
- To investigate the causes, clinical features, radiological findings, and surgical outcomes of traumatic EDH in children under 12 years old.
- To compare pediatric EDH presentation with adult patterns.
Main Methods:
- Retrospective study of 44 children surgically treated for EDH between 1979 and 1994.
- Analysis of neurosurgical referrals, clinical presentations, neurological examinations, radiological (radiographs and CT scans), and post-surgical outcomes.
Main Results:
- Falls were the most common cause (21 cases), followed by motor vehicle accidents (12 cases).
- Atypical presentations were common, with persistent drowsiness (19 patients) and headache/vomiting (17 patients) being frequent. Initial loss of consciousness was less common.
- Parieto-occipital (24 cases) and posterior fossa (11 cases) were the most common locations. 36 out of 44 children had excellent post-surgical outcomes.
Conclusions:
- Pediatric traumatic intracranial extradural haemorrhage often presents atypically compared to adults, with classic lucid intervals being rare.
- Early neurosurgical intervention is associated with favorable outcomes in the majority of pediatric patients with EDH.
Objective:
To determine the cause, clinical presentation, radiological and computed tomography (CT) findings, anatomical position and post-surgical outcome of traumatic intracranial, extradural haemorrhage in children.
Design:
Retrospective study, 1979-1994.
Setting:
Neurosurgical referrals from the Trauma Unit at Red Cross War Memorial Children's Hospital, Cape Town.
Participants:
Forty-four children below the age of 12 years who had extradural haematomas surgically removed.
Results:
Twenty-one extradural haematomas resulted from falls, 12 from motor vehicle accidents, and 6 from assaults; 1 was of unknown cause. Nineteen patients presented with persistent drowsiness (14/15 on the Glasgow Coma Scale), 17 had headache and vomiting, and 13 gave a history of initial loss of consciousness. Seventeen pre-operative neurological examinations were normal, 11 showed anisocoria, 10 hemiplegia, 4 ataxia, 1 nystagmus and 1 a full fontanelle. Cases of posterior fossa haematoma presented with headache and ataxia. Skull fractures were visible on radiographs in 26; computed tomographic diagnosis was made in all but 1. The site of extradural haematoma was parieto-occipital in 24, posterior fossa in 11, frontal in 6, and temporal in 3. Subdural haematomas occurred in 4 cases. Surgical treatment consisted of 41 craniotomies/craniectomies and 3 burr-holes. Postoperatively 36 patients were neurologically normal, 6 had neurological deficits, and 2 died.
Conclusion:
Intracranial extradural haemorrhage in children presents in an atypical manner when compared with adults. An initial loss of consciousness followed by a lucid interval and a progressive deteriorating level of consciousness is the exception rather than the rule. Timeous neurosurgical treatment resulted in an excellent outcome in 36 of the 44 children.