Abstract
Traumatic epidural hematomas are critical emergencies in neurosurgery, and patients symptomatic from acute epidural hematomas are typically treated with rapid surgical decompression. However, some patients, if asymptomatic, may be treated with close clinical observation and serial imaging. Although rare, rapid spontaneous resolution of epidural hematomas in the pediatric population has even been reported, with only seven cases in the literature. Numerous theories have been proposed to explain the pathophysiology behind these cases, including egress of epidural collections through cranial discontinuities (fractures/open sutures), blood that originates in the subgaleal space, and bleeding from the cranial diploic cavity after a skull fracture that preferentially expands into the subgaleal space. We report the case of a rapidly resolving epidural hematoma in a 13-year-old boy. This case allows for more detailed inferences to be made concerning the nature of the epidural hematoma’s resolution, as it is the first reported case in which an intracranial pressure monitor has been utilized. We also review the literature and discuss the nature of rapid spontaneous epidural hematoma resolution.
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References
Kim KA, Wang MY, Griffith PM, Summers S, Levy ML (2000) Analysis of pediatric head injury from falls. Neurosurg Focus 8(e3):1
Obana WG, Pitts LH (1991) Management of head injury. Extracerebral lesions. Neurosurg Clin N Am 2(2):351
Rocchi G, Caroli E, Raco A, Salvati M, Delfini R (2005) Traumatic epidural hematoma in children. J Child Neurol 20–7:569–572
Schutzman S, Barnes P, Mantello M, Scott R (1993) Epidural hematomas in children. Ann Emerg Med 22:535–541
Pang D, Horton JA, Herron JM, Wilberger JE, Vries JK (1983) Nonsurgical management of extradural hematomas in children. J Neurosurg 59:958–971
Knuckey N, Gelbard S, Epstein M (1989) The management of ‘asymptomatic’ epidural hematomas. A prospective study. J Neurosurg 70:392–396
Aoki N (1988) Rapid resolution of acute epidural hematoma. J Neurosurg 68:149–151
Malek A, Barnett F, Schwartz M, Scott R (1997) Spontaneous rapid resolution of an epidural hematoma associated with an overlying skull fracture and subgaleal hematoma in a 17-month-old child. Pediatr Neurosurg 26:160–165
Akagami R, Cochrane D (1999) Does it leak in or does it leak out. Pediatr Neurosurg 30:109–110
Neely J, Jones B, Crone K (2008) Spontaneous extracranial decompression of epidural hematoma. Pediatr Radiol 38:316–318
Eom K, Park J, Kim T, Kim J (2009) Rapid spontaneous redistribution of acute epidural hematoma: case report and literature review. J Korean Neurosurg Soc 45:96–98
Chida K, Yukawa H, Mase T, Endo H, Ogasawara K (2011) Spontaneous slow drainage of epidural hematoma into the subgaleal space through a skull fracture in an infant. Neurol Med Chir (Tokyo) 51:854–856
Tuncer R, Acikbas C, Ucar T, Kazan S, Karasoy M, Saveren M (1997) Conservative management of extradural hematomas: effects of skull fractures on resorption rate. Acta Neurochir (Wien) 139:203–207
Kang S, Chung Y, Lee H (2005) Rapid disappearance of acute posterior fossa epidural hematoma. Neurol Med Chir (Tokyo) 45:462–463
Servadei F, Staffa G, Pozzati E, Piazza G (1989) Rapid spontaneous disappearance of an acute extradural hematoma: case report. The Journal of Trauma 29(6):880–882
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Tataryn, Z., Botsford, B., Riesenburger, R. et al. Spontaneous resolution of an acute epidural hematoma with normal intracranial pressure: case report and literature review. Childs Nerv Syst 29, 2127–2130 (2013). https://doi.org/10.1007/s00381-013-2167-8
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DOI: https://doi.org/10.1007/s00381-013-2167-8