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[Three cases of acute subdural hematoma in abused children]
Insights
Early diagnosis and treatment are crucial for battered children with acute subdural hematoma. Surgical outcomes are often poor due to delayed presentation and severe malnutrition, highlighting the need for prompt intervention and parental support.
Area of Science:
- Pediatric Neurosurgery
- Child Abuse and Neglect
- Trauma Surgery
Background:
- Child abuse is a growing concern, often presenting with severe head injuries like subdural hematomas.
- Surgical intervention for acute subdural hematoma in battered children is frequently complicated.
Observation:
- Three cases of battered children with acute subdural hematoma are presented.
- Patients exhibited signs of abuse, malnutrition, anemia, and varying degrees of head trauma.
- Surgical outcomes were poor in severe cases, with two fatalities despite emergency craniotomy.
Findings:
- Delayed diagnosis and treatment in child abuse cases contribute to poor surgical outcomes.
- Severe anemia and malnutrition significantly complicate management of acute subdural hematoma in battered children.
- Conservative management was successful in one case of chronic subdural hematoma following initial acute injury.
Implications:
- Emphasizes the critical need for early identification and intervention in cases of child abuse.
- Highlights the importance of prompt medical and psychological treatment for both abused children and their families.
- Underscores the challenges in surgical management of acute subdural hematoma in this vulnerable population.
Abstract:
We encountered 3 cases of battered children with acute subdural hematoma. In this report, we discuss the difficulties in treating this condition surgically, and we emphasize the importance of early diagnosis and treatment of abused children and their parents. Case 1: A girl, aged 2 months, was brought in by her mother, because the child had become drowsy. The mother stated that the child had been battered by her father. Physical examination revealed tense anterior fontanelle, bruises on her face, consciousness disturbance and retinal bleeding. Marked anemia was revealed on laboratory studies. A computed tomographic (CT) scan demonstrated an interhemispheric subdural hematoma in the parietooccipital region. She was treated conservatively for 2 months. Follow-up CT revealed a bilateral chronic subdural hematoma. Burr hole irrigation and drainage on both sides brought about complete disappearance of these lesions. Case 2: A girl, aged 1 year and 9 months, was brought in by her parents. According to her mother's allegation, the child fell down from the top of an indoor slide and became comatose. Physical examination revealed severe malnutrition, loss of consciousness, dilated pupils and negative light reflex. Numerous areas of subcutaneous bleeding and skin erosions were seen on her back and abdomen. Marked anemia was revealed on laboratory studies. CT scan demonstrated a left acute subdural hematoma and massive brain swelling. Despite an emergency craniotomy, the child died 5 days later. Case 3: A 4-year-old boy was admitted in a comatose state. According to his mother's allegation, he was thrown to the floor from a 1.5m height and struck against a wall by his father. Physical examination revealed severe malnutrition, consciousness loss, dilated pupils and negative light reflex. Many scratches and bruises were seen over his whole body, especially on his back. Marked anemia was revealed on laboratory studies. A CT scan demonstrated a left acute subdural hematoma and massive brain swelling. Three days later, he died despite emergency craniotomy. The incidence of battered children is increasing in Japan, and these cases sometimes involve severe head injuries, such as subdural hematoma. In these cases, successful surgical treatment is difficult after admission to the neurosurgical institute. This may result from late admission as well as marked anemia and malnutrition. Therefore, we conclude that early diagnosis of child abuse and treatment of the abused child and psychological treatment for their parents are very important.