Posterior fossa epidural hematoma in children

Posterior fossa epidural hematoma in children

Clinical features

Because of the non-specific symptoms and the potential for rapid and fatal deterioration of Posterior fossa epidural hematoma in children, an early computed tomography (CT) scanning is necessary for all suspicious cases.

In nine cases.The clinical picture was dominated by headache, vomiting, and gait ataxia. An occipital fracture was seen in 77.7% of the patients. In all cases, the diagnosis was made by computed tomography. 1).

Treatment

see Review and Management Guidelines 2).

Although some patients have been successfully treated with conservative approach, most studies support timely management of posterior fossa epidural hematoma by surgical intervention in children.

The absence of an occipital skull fracture or the presence of normal pulse rate and blood pressure should not influence the decision. Lumbar puncture is absolutely contraindicated 3).

Little evidence is available regarding the feasibility of using trephination mini-craniectomy for traumatic PFEDH in children 4).

Outcome

The overall prognosis normally is excellent 5) 6) 7).

Torrential venous bleeding can be a major problem due to rupture of the adjacent sinuses. Timely intervention is crucial for achieving good outcome, keeping in view a low threshold for surgical evacuation 8).

Case series

References

1) , 7)

Ciurea AV, Nuteanu L, Simionescu N, Georgescu S. Posterior fossa extradural hematomas in children: report of nine cases. Childs Nerv Syst. 1993 Jul;9(4):224-8. PubMed PMID: 8402704.
2)

Kaushik S, Sandip C. Posterior Fossa Acute Extradural Hematoma in Children: Review and Management Guidelines. J Pediatr Neurosci. 2018 Jul-Sep;13(3):289-293. doi: 10.4103/JPN.JPN_86_18. Review. PubMed PMID: 30271459; PubMed Central PMCID: PMC6144610.
3)

Arkins TJ, McLennan JE, Winston KR, Strand RD, Suzuki Y. Acute posterior fossa epidural hematomas in children. Am J Dis Child. 1977 Jun;131(6):690-2. PubMed PMID: 868823.
5)

Chaoguo Y, Xiu L, Liuxun H, Hansong S, Nu Z. Traumatic Posterior Fossa Epidural Hematomas in Children : Experience with 48 Cases and a Review of the Literature. J Korean Neurosurg Soc. 2019 Mar;62(2):225-231. doi: 10.3340/jkns.2016.0506.007. Epub 2019 Feb 27. PubMed PMID: 30840978.
6)

Sencer A, Aras Y, Akcakaya MO, Goker B, Kiris T, Canbolat AT. Posterior fossa epidural hematomas in children: clinical experience with 40 cases. J Neurosurg Pediatr. 2012 Feb;9(2):139-43. doi: 10.3171/2011.11.PEDS11177. PubMed PMID: 22295917.
8)

Prasad GL, Gupta DK, Sharma BS, Mahapatra AK. Traumatic Pediatric Posterior Fossa Extradural Hematomas: A Tertiary-Care Trauma Center Experience from India. Pediatr Neurosurg. 2015;50(5):250-6. doi: 10.1159/000438488. Epub 2015 Aug 20. PubMed PMID: 26287640.

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