Paediatric traumatic chronic subdural hematoma - a very rare entity

Abstract

Objectives: To study the prevalence of Traumatic chronic subdural hematoma in children.
 Material and methods: This is a prospective study conducted at a tertiary care centre at Gwalior, from November 2020 to November 2021. We encountered 5 patients admitted for signs of raised intracranial tension due to Head trauma, showing Chronic subdural Haematoma ( CSDH) in plain CT  Head or MRI brain. All patients had no history of loss of consciousness, no history of vomiting, no history of seizures, no history of nasal or ear bleed and GCS was 15/15. All blood investigation and coagulation profiles are normal. Frontal and parietal 2.5 cm trephine craniotomy with evacuation of subdural hematoma was done. Patients were followed up at 1 month and 6 months
 Result: All children are male. Age ranging from 7 years to 14 years, Mean age of presentation was 10 years. All patients had a history of head trauma and mode of injury road traffic accidents (RTA)  and Glasgow coma scale(GCS) at admission was 15 and duration of developed CSDH was 20 days to 42 days’(mean30.40 days). All patients had good outcomes and the average follow-up was 6.5 months. All patients went on Surgical intervention. and outcome assessed by Glasgow Outcome score. 3 out of 5 patients had brownish fluid as a collection in subdural space while the other 2 patients had fluid that has motor oil like consistency in subdural space. All the patients were subjected to a similar procedure. The postoperative course was uneventful. Mean hospital stay was 7 days.  A postoperative scan was done on the 7th day.
 Conclusion: Chronic Subdural Hematoma is a disease reported in infants and the elderly population. It is uncommon in the age group of 2-14 years. Most of the children present with symptoms of raised intracranial tension due to head injury, with no reported history of repeated head trauma, child abuse & coagulopathy. Traumatic Chronic subdural collection should be considered as one of the diagnoses as the prognosis of this disease is better. However, due to the scarcity of reports in the literature, established guidelines are not available.