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Major Complications in Supratentorial Epidural Hematoma In Infants (Abstract)

A.V.Ciurea, A.Tascu, F.M.Brehar, A. Iliescu, R. Rizea, C.Palade
First Neurosurgical Department
Clinical Hospital “Bagdasar-Arseni”,
Bucharest, Romania



Aim: Traumatic epidural hematoma (EDH) represents a rare head injury complication in infants. Its diagnosis can be quite challenging because its clinical presentation is usually subtle and nonspecific. The aim of this study was to establish the criteria for the surgical versus conservative management of EDH in infants and to underline the main complications of this traumatic affection. Materials and methods: Authors present a study on 30 infants with epidural hematoma (EDH) admitted in the Pediatric Department of Neurosurgery of the Clinic Hospital “Bagdasar-Arseni” in the period of 1990-2008 (19 years). The mean age of series was 10 months. The Children Coma Scale (CCS) at admission ranged between 13-15 in 11 cases (36,6%), 9-12 in 13 cases (43,3%) and 4-8 in 6 cases (20,1%). The most common presenting symptom was irritability, which occurred in 16 cases (53.3%), of our patients. 

Results: Patient management was either surgical or conservative based on the infant’s clinical condition, Children Coma Scale (CCS) score, TINS score, evidence of midline shift on the initial head CT scan, and size of the EDH. In 26/30 cases (86.6%) the size of the EDH was more than 2 cm with midline shift. These underwent to surgical intervention in emergency. Surgical management consisted of craniotomy under general endotracheal anesthesia and removal of the underlying hematoma. The remained 4/30 cases (13.4%) with low size EDH without mass-effect and CCS of 13-15 were managed conservatively. The mortality rate in our series was 6,6%.

Conclusions: EDH in infants represents a life-threatening complication of head injury, which requires early identification and prompt surgical or conservative management depending on the patient’s clinical condition, size of EDH, and presence of midline structure shift on head CT scan.

key words: epidural hematoma, infant, pallor, Children Coma Scale (CGS), Traumatic Infant Neurologic Score (TINS), Outcome.



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