Hematoma In Children Research Articles

Conservative management of significant epidural haematomas in children

A significant epidural haematoma (EDH) is generally treated by craniotomy and evacuation. This is a report of conservative management following an EDH on computerized tomography (CT) in a paediatric population. The authors examined whether conservative treatment of radiologically significant EDH is a successful and safe therapeutic option. Retrospective data were collected from charts of patients with conservatively treated EDH in the Department of Surgery of the University Children's Hospital Zurich between September 1993 and January 2004. Included were patients without focal neurological deficits, with a Glasgow Coma Scale (GCS) of 15 and an initial CT demonstrating an EDH with a minimal thickness of 1 cm. Mild clinical symptoms of raised intracranial pressure such as headache, nausea or vomiting were treated symptomatically. Follow-up included a standardized interview, a neuropaediatric examination and CT. Thirteen children with EDH had successful conservative management. Only one 12-year-old female patient with a delayed diagnosed frontal EDH required surgical intervention 24 h after admission and 5 days after the accident. Clinical follow-up showed patients without neurological deficits, a Glasgow Outcome Scale of 5 and no post-traumatic sequelae over an average of 4 4/12 years (range 4 months to 10 4/12 years). Follow-up CT showed complete resolution of the EDH within 2 to 3 months. Our results demonstrate that significant EDH can be treated non-operatively in neurologically normal children. We recommend that such treatment be performed in specialised paediatric centres under adequate neurological observation since prompt emergency operation in case of neurological deterioration should be provided.

Isolated extradural hematoma in children presenting to an emergency department in Australia.

Isolated extradural hematoma (EDH) is becoming more frequently recognized in emergency departments (EDs) in children. We describe the natural history of children with isolated EDH presenting to a large Children's Hospital ED. This is a descriptive case series study using a retrospective review of the medical records of children presenting to the ED with a diagnosis of isolated EDH over 8 years. Comparison was made with children having other injuries in addition to EDH. The cause, nature of injury, presentations to hospital, management, outcome, and any association with nonaccidental injuries (NAI) were analyzed. Of the 35 cases with a final diagnosis of isolated EDH initially presenting to the ED, 70% were over 3 years of age (mean 6.6 years), and 60% were boys. A fall of less than half a meter was the cause of isolated EDH in 51.4% of patients. The remaining cases resulted from a fall from a height greater than half a meter (17.1%), a motor vehicle accident (11.4%), being hit by an object (8.6%), a bicycle accident (5.7%), and a skateboard accident (5.7%). Children younger than 3 years presented within 24 hours of injury in 70% of cases, compared with 65% of older children. In 95% of cases, presentation was nonspecific, suggesting a medical rather than a surgical problem. This resulted in a delay in seeking emergency care and a delay in final diagnosis for these patients. Surgical drainage was required in 68.6% of cases, with older children being more likely to be managed conservatively. In 23.4% of cases, minor residual neurologic deficit occurred; there were no cases of serious long-term problems. There were no cases of NAI in the children studied. This report highlights falls as a common cause of isolated EDH in children. Delay in presentation for clinical assessment is common, because many children have nonspecific presentation that is suggestive of a medical problem. No cases of NAI were reported in this study.

Etiology Of Spontaneous Perirenal Hemorrhage: A Meta-Analysis

Etiology Of Spontaneous Perirenal Hemorrhage: A Meta-Analysis

Shaken Baby Syndrome: fundamental questions

More than 30 years have passed since the original publication by Caffey1 proposing the hypothesis of causing injury to infants by manual shaking, and the Shaken Baby Syndrome currently enjoys worldwide clinical attention. In the United States alone, large amounts of federal funding, passing through the individual states, provide support for comprehensive child protective services, including the evaluation of reported instances of injury by shaking, the establishment of cases of purported child abuse by shaking, and the prosecution and resolution of these cases These cases achieve widespread national and sometimes international2 publicity, and well-intentioned health-care providers, such as physicians, nurses, paramedical personnel and social workers are often held up to close public scrutiny regarding their respective positions on this subject. While the legislatures, the media, and even some portions of the health-care professions have been quick to adopt a posture regarding the presence of child abuse as a general premise, and avoidance of injury to children by shaking specifically, a careful review of the facts surrounding the original hypothesis, plus subsequent recorded experimental data, raises questions which may have some significance here. To begin with, Caffey in 1972 published the first definitive clinical article entitled ‘On the Theory and Practice of Shaking Infants’, referenced earlier. In reading this article, the only reference directly linking subdural haematomas, regarded as the hallmark injury in shaking, with violent to and fro movement of the neck, is an article published one year earlier by Guthkelch,3 in which the latter author references as a biomechanical basis for the concept of manual shaking causing subdural hematomas in children, earlier experimental work by Ommaya.4 Indeed, in reading the original papers by Guthkelch and Caffey, Ommaya’s work emerges as the only experimental verification for the hypothesis of causing subdural haematomas in infants by manual shaking, all else being retrospective clinical observation or anecdotal report. It would seem therefore that the original work by Ommaya should be examined closely. In 1968, Ommaya attempted to establish experimentally whether intracranial injuries could be produced by rotational displacement of the head on the neck alone, without significant direct head impact. This series of experiments was performed in the light of previously published reports of cerebral concussion and other evidence for central nervous system involvement after whiplash injury in man. In this experiment, anaesthetized rhesus monkeys were secured in a contoured fibreglass chair mounted on a rigid carriage. This carriage was mounted on wheels placed on a track, and a piston was used to deliver an impulse to the carriage, propelling the animal forward, simulating a rear end motor vehicle collision, the actual point of interest in the experiment. The entire event was photographed with a high-speed camera, enabling a calculation of rotational acceleration of the head, this acceleration being measured in radians/s2, the radian being that portion of the circumference of a circle enclosed by arc of 57.29 degrees, or the radius of a circle measured along its circumference. Ommaya was able to produce clinical and pathologically demonstrated intracranial injury in the form of concussion, subdural haematoma, and parenchymal injury to brain tissue in 19 animals, 11 of which also had pathologically demonstrated neck injuries. He also demonstrated that rotational acceleration exceeding 40,000 radians/s2 was sufficient to produce experimental concussion, without impact to the head. Ommaya postulated from these data that the levels of angular acceleration required to produce cerebral concussion and brain injury in man without impact should be in the order of 6000– 7000 radians/s2 a figure he revised downward later to 4000 radians/s2.5 This is based on a formula

Hématome épidural chez l’enfant hémophile : difficultés diagnostiques

Spinal epidural hematoma is an uncommon complication in hemophilia. Case reports. – The cases of an extensive epidural hematoma in two boys with severe hemophilia are reported. Conclusion. – Acute onset of severe neck pain or backache leads to the diagnosis of epidural hematoma in children with hemophilia, even in the absence of neurologic symptoms. Early diagnosis is important and relies on magnetic resonance imaging. Replacement therapy is mandatory and must be prescribed before neuroradiologic imaging. Generally, children have a good neurologic outcome.

Arthrotomy and Open Reduction of the Displaced Fracture of the Femoral Neck in Children

The objective of the study was to examine the efficacy of limited arthrotomy coupled with open reduction and internal fixation to minimize potential complications of vascular disruption of the capital femoral physis and femoral epiphysis. It was a patient outcome study. Skeletally immature patients with femoral neck fractures were treated according to a protocol in which all patients underwent limited arthrotomy with decompression of the intercapsular hematoma, open reduction and internal fixation. Radiographic and magnetic resonance imaging studies were carried out on patients to assess whether avascular necrosis developed in the postoperative period. Patients were followed for a mean length of 2 years 8 months, with a range of 2 years to 5.5 years. Twelve patients had good results and one had fair results using Ratliff criteria. No patient developed avascular necrosis (ischemic necrosis), coxa vara, nonunion or premature epiphyseal closure. This study supports the hypothesis that limited decompression of the intracapsular hematoma in children with femoral neck fractures may be a factor in obviating the subsequent appearance of ischemic disruption of the epiphysis and physis.

Arthrotomy and Open Reduction of the Displaced Fracture of the Femoral Neck in Children

Summary: The objective of the study was to examine the efficacy of limited arthrotomy coupled with open reduction and internal fixation to minimize potential complications of vascular disruption of the capital femoral physis and femoral epiphysis. It was a patient outcome study. Skeletally immature patients with femoral neck fractures were treated according to a protocol in which all patients underwent limited arthrotomy with decompression of the intercapsular hematoma, open reduction and internal fixation. Radiographic and magnetic resonance imaging studies were carried out on patients to assess whether avascular necrosis developed in the postoperative period. Patients were followed for a mean length of 2 years 8 months, with a range of 2 years to 5.5 years. Twelve patients had good results and one had fair results using Ratliff criteria. No patient developed avascular necrosis (ischemic necrosis), coxa vara, nonunion or premature epiphyseal closure. This study supports the hypothesis that limited decompression of the intracapsular hematoma in children with femoral neck fractures may be a factor in obviating the subsequent appearance of ischemic disruption of the epiphysis and physis.

Arthrotomy and Open Reduction of the Displaced Fracture of the Femoral Neck in Children

Summary: The objective of the study was to examine the efficacy of limited arthrotomy coupled with open reduction and internal fixation to minimize potential complications of vascular disruption of the capital femoral physis and femoral epiphysis. It was a patient outcome study. Skeletally immature patients with femoral neck fractures were treated according to a protocol in which all patients underwent limited arthrotomy with decompression of the intercapsular hematoma, open reduction and internal fixation. Radiographic and magnetic resonance imaging studies were carried out on patients to assess whether avascular necrosis developed in the postoperative period. Patients were followed for a mean length of 2 years 8 months, with a range of 2 years to 5.5 years. Twelve patients had good results and one had fair results using Ratliff criteria. No patient developed avascular necrosis (ischemic necrosis), coxa vara, nonunion or premature epiphyseal closure. This study supports the hypothesis that limited decompression of the intracapsular hematoma in children with femoral neck fractures may be a factor in obviating the subsequent appearance of ischemic disruption of the epiphysis and physis.

Spontaneous Extradural Hematoma in Children with Sickle Cell Disease: Case Report and Literature Review

Spontaneous Extradural Hematoma in Children with Sickle Cell Disease: Case Report and Literature Review

Chronic Subdural Hematoma in Children

Chronic subdural hematoma (CSH) is generally a disease affecting the elderly and infants. In infants, the process is particularly confusing and frequently misunderstood. In the pediatric population, CSH is just one of a group of sometimes related conditions known as extracerebral fluid collections. In the past, extracerebral fluid collections, in general, and CSHs, in particular, have been inaccurately or incompletely described. Modern neuroimaging techniques, however, have greatly advanced our understanding of these conditions. Surprisingly little literature exists on the subject, and publications before the advent of modern computed tomography and magnetic resonance imaging should be interpreted with caution.

073 Chronic subdural haematomas in children with arachnoid cysts of the brain

073 Chronic subdural haematomas in children with arachnoid cysts of the brain

Subdural hematomas in children under 2 years. Accidental or inflicted? A 10-year experience

Objective: The aim of this study was to determine the relative frequency of child abuse, accidents and disease as a cause of subdural hematomas in children under 2 years of age, and to determine the main clinical features at presentation, that may help to distinguish these groups of patients. Method: A retrospective review was undertaken of the medical records of all children under 2 years of age admitted to the Royal Alexandra Hospital for Children with the diagnosis of subdural hematoma in the 10-year period January 1987 to December 1996. Results: Thirty eight children were identified with subdural hematomas during the study period. The commonest cause was nonaccidental injury in 55% of cases, accidents in 39% and nontraumatic causes (6%) made up the remainder. The nonaccidental injury cases were significantly younger than the accidentally injured children. The most important clinical features were the significantly higher incidence of retinal hemorrhages and associated long bone and rib fractures in the abuse group. Delay in presentation for medical evaluation was also more commonly seen in the abused children. Conclusion: Nonaccidental injury is the commonest cause of subdural hematomas in children under 2 years of age. The presence of retinal hemorrhages, bone and rib fractures, delay in presentation and the young age of the infants, suggests child abuse is the most likely cause of these injuries.

Spontaneous spinal epidural hematoma in children

Spontaneous spinal epidural hematoma is rare in children. It is usually confined to the dorsal epidural space. Ventral spontaneous spinal epidural hematoma (SSEH) is rarer, with only two previous reports. The authors present three children, two with dorsal and one with ventral spinal epidural hematoma, and review the literature. No etiology of the hematoma was found in the authors’ patients and there was no history of trauma. A review of 24 patients of children younger than 18 years of age reported in the literature and the authors’ three patients revealed that the cervicothoracic region was the most common site of SSEH, the mode of onset was frequently subacute, and there was no male preponderance as has been reported in adults. We found that the initial symptoms were often nonspecific, leading to a delay in diagnosis, especially in younger children. Follow-up data revealed that 15 of the 27 patients recovered completely, 11 had residual neurologic deficits, and one patient died. Irritability and neck pain with restricted movements of the cervical spine in an afebrile child may be early signs of SSEH and often precede onset of neurologic deficits by several hours to days. These signs should alert the clinician to consider spinal epidural hematoma and the need for urgent magnetic resonance imaging (MRI) of the spine for early diagnosis and treatment to minimize morbidity.

Scalp hematomas in children after hair braiding

We report two cases of scalp hematoma occurring in girls after the braiding of their hair. Subgaleal hematoma has been reported in children after relatively minor head trauma. We propose that the tension placed on the scalp during the placement of tight rows of hair braids is sufficient to result in such hematomas.

Outcome after spontaneous spinal epidural hematoma in children: Case report and review of the literature

Objective: Spontaneous spinal epidural hematoma (SSEH) is an idiopathic accumulation of blood in the vertebral epidural space without identifiable predisposing factors. First reported in 1869, the clinical outcome in children younger than 18 years old has not been clearly delineated. Design: A comprehensive review of the English language literature revealed 26 patients younger than 18 years old with reported clinical outcomes. The 27th case is presented. Results: Complete neurologic recovery occurred in 14 of 27 (52%) patients, partial recovery in 12 of 27 (44%) patients, and death in 1 of 27 (4%) patients. Conclusion: There is an overall good prognosis for neurologic recovery in children who experience SSEH.

Hematomas intraparenquimatosos: particularidades en los niños

Intraparenchymatous haemorrhages are rare in infancy, but their effects may be very harmful. The aetiology, clinical characteristics and prognosis regarding life and function are different from those in adults. We decided to analyze the characteristics of this pathology in children and compare them with those in adults. We reviewed the clinical histories of the patients under 13 years of age presenting with a spontaneous intraparenchymatous haemorrhage during a 10 year period. The study group was made up of 10 patients, 5 boys and 5 girls, aged between 23 days and 11 years. In 7 patients the aetiology was a burst arteriovenous malformation; in one a serious liver disorder due to alpha-l-antitrypsin deficiency; bleeding from an undiagnosed tumour caused another case and no aetiology was found in a further case. Two patients died, 6 patients had residual neurological defects and in the other two there were no sequelae. Intraparenchymatous haematomas in children have a high mortality (20%) and many sequelae. The figures are comparable with those for elderly persons aged over 70 and much greater than in the case of young adults. The commonest aetiology is an arteriovenous malformation, followed at a considerable distance by coagulopathies and tumours.

Radiological and clinical criteria for the management of epidural hematomas in children.

Modern neuroimaging and intensive care permit precise delineation and specific treatment of head injury. Children sustaining cranial trauma associated with epidural hematoma (EDH) represent a heterogeneous group with a variety of clinical outcomes. Treatment consists of simple observation or surgical evacuation. We attempted to define radiological characteristics of the EDH patients that underwent surgical evacuation. We reviewed the records and computed tomography scans of 33 children sustaining cranial trauma associated with EDH treated at the Children's National Medical Center between October 1990 and August 1994. The radiological and clinical characteristics of children treated surgically (n = 13) and nonsurgically (n = 20) were compared. Mass effect, a temporal clot location, thickness, length and volume of the clot, and midline shift (p < 0.05) differed significantly between groups. The most important radiological parameters in determining the therapeutic intervention were thickness, midline shift, mass effect, and EDH location. A thickness of the EDH > 18 mm, a midline shift >4 mm, and moderate or severe mass effect correctly predicted therapy in 29 out of 33 patients. By adding the location as a fourth parameter, therapy was accuratly predicted in 31 of 33 patients. Mechanism of injury, interval from injury to initial computed tomography scan, age, sex, Glasgow coma score on admission, or lengths of hospital and intensive care unit stays were not significantly different between groups. Although radiological criteria predict surgical intervention for larger EDH, patients harboring intermediate-size EDH will continue to require careful individualized clinical judgement.

Characteristics and Prognosis of Extradural Hematomas in Children

This is a report on 31 children with operated extradural hematoma. The aim of the study was to elucidate the characteristics of extradural hematoma in childhood and the different clinical pattern and outcome compared to adults. For that reason the charts of the patients seen at the Department of Surgery of the Children's University Hospital Zurich between 1972 and 1990 have been revised. Follow-up criteria were recorded according to the Glasgow Outcome Scale. Most hematomas have been provoked by minor injuries and almost all children presented with at least one typical clinical sign. Associated intracranial injuries have been found in four patients, while two were polytraumatised. 30 of the 31 patients survived. One patient died of malignant brain edema. The mean range of follow-up was seven years. 28 patients had a "good recovery", "moderate disability" and "severe disability" was found in a patient one each. Our results demonstrate that the long-term outcome in children with extradural hematoma is far better than in adults regarding survival as well as quality of life. The causes may be minor traumas with fewer associated lesions and presentation with typical clinical findings and therefore early diagnosis and treatment.

Childhood extradural haematomas, not always obvious

AbstractExtradural haematomas in children are rare, but they may occur following a trivial head injury. We report a case where, following an unrecognised head injury to a three‐year‐old child, the insidious non‐specific presentation of the extradural haematoma led to delay in the diagnosis and treatment.

Risks of acute traumatic intracranial haematoma in children and adults: implications for managing head injuries.

To determine the factors influencing the risk of an acute traumatic intracranial haematoma in children and adults with a recent head injury. Prospective study of incidence of risk factors in samples of patients attending accident and emergency departments and in all patients having an acute traumatic intracranial haematoma evacuated in one regional neurosurgical unit during 11 years. Accident and emergency departments in Scotland or Teesside and regional neurosurgical centre in Glasgow. 8406 Adults and children (less than or equal to 14 years) who attended accident and emergency departments and 1007 consecutive patients who had an operation for an acute traumatic intracranial haematoma. Data were complete in 8366 and 960 patients respectively. Overall, children were less at risk than adults (one in 2100 v one in 348 respectively). In both age groups the presence of a skull fracture and changes in conscious level permitted identification of subgroups of patients with widely differing degrees of risk. In children the absolute risk ranged from one in almost 13,000 without a fracture or altered conscious level to one in 12 for a child in a coma and with a fracture; the pattern was similar in adults, the risks in corresponding groups ranging from one in almost 7900 to one in four. Although children attending hospital after a head injury have a lower overall risk of a traumatic haematoma, the main indicators of risk, a skull fracture and conscious level, are the same as in adults, and the pattern of their combined effect is similar. Guidelines for managing adults with recent head injury may therefore be applied safely to children; with the increasing provision of facilities for computed tomography they should be revised to ensure early scanning of more patients with head injury.