Traumatic Acute Giant Epidural Hematoma in a Hydrocephalic Shunted Child

• Published in: Pediatric neurosurgery Vol. 32; no. 4; pp. 176 - 179
• Main Authors: Bor Seng Shu, Edson, Leme, Ricardo Jose de Almeida, Aguiar, Paulo Henrique, de Andrade, Almir Ferreira, Teixeira, Manoel Jacobsen, Plese, José Píndaro Pereira
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland Karger 01.04.2000; S. Karger AG
• Subjects: Accidental Falls; Biological and medical sciences; Child, Preschool; Diagnosis, Differential; Emergency Treatment; Fatal Outcome; Glasgow Coma Scale; Hematoma, Epidural, Cranial - diagnostic imaging; Hematoma, Epidural, Cranial - etiology; Humans; Hydrocephalus - surgery; Infant; Injuries of the nervous system and the skull. Diseases due to physical agents; Male; Medical sciences; Original Paper; Skull Fractures - complications; Skull Fractures - diagnostic imaging; Tomography, X-Ray Computed; Traumas. Diseases due to physical agents; Tropical medicine; Ventriculoperitoneal Shunt; Ventriculoperitoneal shunt; Asymptomatic epidural hematoma; Computerized tomography; Human; Nervous system diseases; Large dimension; Craniocerebral; Diseases of the osteoarticular system; Cardiovascular disease; Male; Asymptomatic; Cerebrospinal fluid; Trauma; Cerebral disorder; Vascular disease; Case study; Extradural; Bypass; Central nervous system disease; Hematoma; Skull disease; Complication; Diagnosis; Hydrocephaly; Child
• ISSN: 1016-2291; 1423-0305
• DOI: 10.1159/000028930

Extradural hematoma (EDH) is considered to be a rare complication of head trauma in children, and represents a serious and urgent pathology from which complete recovery can be expected if specialized treatment is instituted in time. In this article, the authors report the potential danger to a hydrocephalic shunted child who was apparently asymptomatic at the time of hospital admission with a mild head injury and developed an EDH of venous origin. This child had a rapid (time interval from injury to decerebrate posture of about 2 h), atypical (remained asymptomatic most of the time until abruptly deterioration) and fatal course, stressing the importance of early diagnosis and rapid therapy in order to avoid the death of the patient. The authors discuss the role of the ventriculoperitoneal shunting system in the lack of clinical symptoms associated with the presence of a giant EDH and a rapid and fatal course, and stress the importance of computed tomographic (CT) scanning in these patients, even if they are asymptomatic. If a skull fracture is suspected, a CT scan must be performed without delay.