Characteristics of Traumatic Intracerebral Hematomas in Children

Abstract

The authors retrospectively compared various features of traumatic intracerebral hematoma (TICH) in 15 children and 25 adults. The patients were divided into two groups according to the hematoma site, i.e., cortical/subcortical and central, and their clinical courses, neurological findings and, in particular, computed tomography (CT) scans were analyzed. Most of hematomas in the cortical/subcortical group developed as a result of cerebral contusion. The majority of children in this group were males and trauma was mainly incurred in traffic accidents. On the other hand, falls as well as traffic accidents were the primary causes of TICH in the adults. Most cortical/subcortical hematomas developed soon after head injury, although some evolved gradually in an area that had appeared isodense on the initial CT scan. Completion of this type of hematoma took longer in children than in adults. In pediatric patients, TICHs often were located in the occipital and parietal lobes, whereas most of the adult TICHs developed in the frontal and anterior temporal lobes. TICHs and their causative contusions were generally smaller in the pediatric population and less frequently required surgery, the operative rates being 22.2% among children and 85.7% among adults. In children, the outcome of cortical/subcortical TICH was favorable. Small hematomas in the corpus callosum, basal ganglia, and paraventricular region were included in the central hematoma group. These hematomas were believed to have developed through shearing strain. The incidence of central hematoma was significantly higher in children than in adults, and the adults in this group tended to be young. The outcome in children was somewhat better than that in adults.