Spontaneous rapid resolution of an epidural hematoma associated with an overlying skull fracture and subgaleal hematoma in a 17-month-old child

Pediatric Neurosurgery
A M MalekR M Scott

Abstract

Acute traumatic epidural hematomas (EDH) constitute one of the most critical emergencies in neurosurgical management. The rapid spontaneous resolution (<24 h) of EDH is an extremely rare phenomenon. A 17-month-old patient fell from a height of 1.5 m and presented with a 8-mm temporal EDH, an overlying linear skull fracture, and a subgaleal hematoma without evidence of intraparenchymal injury or edema. The patient complained only of mild headache, harbored no neurological deficits, and was, therefore, managed conservatively in the intensive care unit with provision to proceed to surgical decompression in the event of neurological change. A repeat CT study 18 h later revealed near-complete resolution of the EDH with a coincident increase in the volume and spread of the subgaleal hematoma. This is the fourth reported case of rapid spontaneously resolving EDH and the youngest one to date. All 4 cases have coincided with an overlying linear skull fracture. We propose that unlike classical EDH, rapidly resolving EDH in the absence of elevated intracranial pressure (ICP) originates from elevated interstitial pressure in the subgaleal compartment transiently decompressing into the epidural space through a skull fracture and resolving a...Continue Reading

Citations

Oct 27, 2007·Pediatric Radiology·John C NeelyKerry R Crone
May 19, 2009·Pediatric Radiology·Handan Cakmakci
May 28, 2013·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Zachary TatarynSteven Hwang
Oct 1, 2005·Neurologia Medico-chirurgica·Shin-Hyuk KangHoon-Kap Lee
Jan 21, 2014·The Journal of Emergency Medicine·Elif YakaSerkan Yılmaz
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