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Spontaneous rapid resolution of acute subdural hematoma in children

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Abstract

Background

Spontaneous rapid resolution of acute subdural hematoma developing secondary to trauma has been reported in the literature, yet it is very rare in pediatric population. The aim of the present review is to analyze mechanisms, characteristics, and outcomes of pediatric acute subdural hematoma cases with spontaneous rapid resolution in conjunction with an exemplary case of ours.

Case description

A 3-year-old boy was admitted to our emergency department following mild head trauma secondary to a fall from 2 m. He was alert and has a GCS of 15. He had no motor or sensorial deficit on neurological examination. On the emergent brain computed tomography image, an acute subdural hematoma over left frontoparietal lobe was observed. There was a midline shift of 8.3 mm and the width of the hematoma at the thickest portion was 11.2 mm. Surgery was postponed with a close neurological follow-up of the patient in pediatric intensive care unit, due to his well neurological status without any increased ICP findings. On the fourth hour follow-up head CT image, amount of midline shift and hematoma thickness were observed to have regressed dramatically. At the second week, the hematoma resorbed totally with only conservative approach, and he was discharged to home in well status.

Discussion and conclusion

Analysis of 12 pediatric patients revealed a mean and median ages of 6.87 and 3.9 years, respectively (range = 8 months–18 years). Causes for ASH development were fall, traffic accident, struggle, and child abuse. Main clinical presentations were with depressed sensorium, coma, stupor, drowsiness, headache, motor weakness, lethargy, and seizure. Close follow-up with conservative treatment should be mode of approach in pediatric patients with ASH, if neurological and radiological findings are favorable. However, if patients’ neurological status deteriorates after admission to hospital, surgery should be conveyed with no further delay.

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Acknowledgments

Murat Şakir Ekşi, M.D., was supported by a grant from TUBITAK (The Scientific and Technological Research Council of Turkey), grant number: 1059B191400255.

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Authors and Affiliations

  1. Department of Neurosurgery, Batman State Hospital, Batman, Turkey

    Ahmet Öğrenci & Mustafa Karakuş

  2. Department of Orthopedic Surgery, Spine Center, University of California at San Francisco, 500 Parnassus Avenue, MU320 West, San Francisco, CA, 94143-0728, USA

    Murat Şakir Ekşi

  3. Department of Neurosurgery, Göztepe Medikal Park, İstanbul, Turkey

    Orkun Koban

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  1. Ahmet Öğrenci
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  2. Murat Şakir Ekşi
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  3. Orkun Koban
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  4. Mustafa Karakuş
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Correspondence to Murat Şakir Ekşi.

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Öğrenci, A., Ekşi, M.Ş., Koban, O. et al. Spontaneous rapid resolution of acute subdural hematoma in children. Childs Nerv Syst 31, 2239–2243 (2015). https://doi.org/10.1007/s00381-015-2910-4

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  • DOI: https://doi.org/10.1007/s00381-015-2910-4

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