Acute epidural hematoma with infarction of the right hemisphere in a 5-month-old child: case report with a long-term follow-up and a review of the literature

• Published in: Journal of child neurology Vol. 23; no. 9; p. 1066
• Main Authors: Ulrich, Peter T, Fuessler, Helmut, Januschek, Elke
• Format: Journal Article
• Language: English
• Published: United States 01.09.2008
• Subjects: Accidental Falls; Acute Disease; Age Factors; Brain - diagnostic imaging; Brain - pathology; Brain Infarction - diagnostic imaging; Brain Infarction - etiology; Brain Infarction - pathology; Consciousness Disorders - etiology; Decompression, Surgical; Disease Progression; Female; Follow-Up Studies; Functional Laterality - physiology; Head Injuries, Closed - complications; Head Injuries, Closed - diagnostic imaging; Head Injuries, Closed - pathology; Hematoma, Epidural, Cranial - complications; Hematoma, Epidural, Cranial - diagnostic imaging; Hematoma, Epidural, Cranial - pathology; Humans; Infant; Magnetic Resonance Imaging; Neurosurgical Procedures; Paresis - etiology; Recovery of Function - physiology; Time; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 1708-8283
• DOI: 10.1177/0883073808315411

Two hours after a fall, a 5-month-old girl was admitted to our hospital because of an extended galea hematoma and restlessness. Five hours after the trauma, a left hemiparesis developed. The child became drowsy. The hematocrit had fallen to 7.1 g/dL. Cranial computerized tomography disclosed a huge frontoparietal epidural hematoma on the right side and a hypodensity in the territories of the middle and posterior cerebral arteries. Immediately before surgery, the right pupil dilated. After evacuation of the epidural hematoma and ligation of the middle meningeal artery, the girl recovered satisfactorily. Nevertheless, magnetic resonance imaging showed a vast defect zone in the territories of the right middle and posterior cerebral arteries. Six weeks after the injury, the visual-evoked potentials were unavailable on both sides. Four years after the accident, visual assessment revealed normal acuity and stereopsis. Cognitive and neuromotor development were undisturbed and appropriate to the age.