HEAD TRAUMA IN CHILDREN WITH HEMOPHILIA

Abstract

Central nervous system bleeding is the main cause of death in hemophilia accounting for 34% of all deaths. Between January 1981 and December 1983, 26 children with hemophilia ranging in age from 1 to 17 years (mean of 7.5 ± 4.5) had 67 hospital admissions for head trauma. Eighteen had Factor VIII, seven Factor IX deficiency and one Von Willebrand's Disease. Of the 26 children, 17 had severe hemophilia and 2 had Factor VIII inhibitors. All patients had scalp hematoma; 3 had lacerations at the site of the hematoma; 1 had severe cerebral concussion; 3 had a history of possible loss of consciousness; 12 had headache; 1 had vomiting and 4 had dizziness on admission. All patients received factor replacement therapy within 12 hours of trauma and factor levels were maintained over 50% for 2 to 9 days (mean 2.7 ± 1.1) and all recovered without sequelae. Eightteen patients had skull x-rays on 38 occasions, all of which were negative. Six patients had EEGs, all of which were normal. Of 20 patients who had CT scans on 25 occasions, all were negative. Hemophilia patients treated with adequate factor replacement following head trauma have an excellent prognosis and in the absence of persistent neurological signs or symptoms probably do not require CT examination.