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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; 62:225-231. [PMID: 30840978 PMCID: PMC6411576 DOI: 10.3340/jkns.2016.0506.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 01/09/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Epidural haematoma (EDH) most commonly occurs in the supratentorial area, particularly in the temporal region, of the brain. Posterior fossa epidural haematoma (PFEDH) is less frequently observed, accounting for only 1.2% to 12.9% of all EDH cases. Because of the non-specific symptoms and the potential for rapid and fatal deterioration in children, an early computed tomography (CT) scanning is necessary for all suspicious cases. The aim of the present study was to share the experience of 48 cases and review the literature concerning PFEDH. METHODS A retrospective analysis was conducted for 48 paediatric cases diagnosed with PFEDH and admitted to Yuying Children's Hospital of Wenzhou Medical University from January 2010 to August 2015. The clinical features and outcomes were analyzed and compared with previous literature. RESULTS Seventeen patients were surgically treated in this series and 31 patients received non-operative treatment. The outcomes were good in 46 patients, evaluated using the Glasgow outcome score (GOS), while mild disability was observed in one patient, and only one case showed severe disability. There were no cases of mortality in this series. CONCLUSION Posterior fossa epidural haematoma is relatively rare compared with supratentorial epidural haematoma. Early and serial CT scans should be performed for all suspicious cases. The criteria for the surgical treatment of paediatric patients with PFEDH were concluded. The overall prognosis was excellent in paediatric patients.
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Affiliation(s)
- You Chaoguo
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou , China
| | - Long Xiu
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou , China
| | - Hu Liuxun
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou , China
| | - Sheng Hansong
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou , China
| | - Zhang Nu
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou , China
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Faheem M, Jaiswal M, Ojha BK, Chandra A, Singh SK, Srivastava C. Traumatic Pediatric Extradural Hematoma: An Institutional Study of 228 Patients in Tertiary Care Center. Pediatr Neurosurg 2019; 54:237-244. [PMID: 31288223 DOI: 10.1159/000501043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/19/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Extradural hematoma (EDH) is one of the most common causes of mortality and morbidity after traumatic brain injury in pediatric patients. Early surgical intervention in these patients produces excellent results. OBJECTIVE We reviewed surgical experience at our center, examining and presenting symptomatology and outcome analysis. MATERIALS AND METHODS A retrospective study of 228 pediatric patients of EDH from July 2007 to August 2017 was performed. Patients were evaluated in terms of demographic profile, clinical features, pupillary size and reaction, computed tomography findings, operative measures, and several other parameters. Neurological status was assessed using motor component (M) of Glasgow Coma Scale score. Best motor response was considered as a criterion to classify severity of traumatic brain injury and for the assessment of outcome. RESULTS Most of the patients were in the age group of 13-18 years (n = 122, 53.5%). Majority of them were male (n = 182, 79.8%). The commonest mode of injury was fall from height (n = 116, 50.9%) followed by road traffic accident (n = 92, 40.4%). Most common site of hematoma was frontal region (n = 66, 28.9%) followed by parietal region (n = 54, 23.7%). The volume of hematoma was between 30 and 50 mL in majority of the patients (n = 186, 81.6%), and most of the patients had a motor responses of M5 (n = 88, 38.6%) and M6 (n = 108, 47.4%). The association between hematoma site and volume was not significant (χ2 = 5.910, p = 0.749), whereas statistically significant association was noted between volume of hematoma and motor response (χ2 = 93.468, p ≤ 0.001), volume and age (χ2 = 7.380, p ≤ 0.05), and volume to time between trauma and surgery (χ2 = 8.469, p ≤ 0.05). Maximum mortality was in patients of low motor (M1-M3) response and who were operated 24 h after injury. CONCLUSION Mortality in patients of EDH can be significantly reduced with gratifying results if operated early. Best motor response at presentation, pupillary abnormalities, time between injury to surgery, and location of hematoma have been identified as the important factors determining outcome in patients of EDH.
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Affiliation(s)
- Mohd Faheem
- Department of Neurosurgery, Uttar Pradesh University of Medical Sciences, Etawah, India
| | - Manish Jaiswal
- Department of Neurosurgery, King George's Medical University, Lucknow, India,
| | - Bal Krishna Ojha
- Department of Neurosurgery, King George's Medical University, Lucknow, India
| | - Anil Chandra
- Department of Neurosurgery, King George's Medical University, Lucknow, India
| | - Sunil Kumar Singh
- Department of Neurosurgery, King George's Medical University, Lucknow, India
| | - Chhitij Srivastava
- Department of Neurosurgery, King George's Medical University, Lucknow, India
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Umerani MS, Abbas A, Aziz F, Shahid R, Ali F, Rizvi RK. Pediatric Extradural Hematoma: Clinical Assessment Using King's Outcome Scale for Childhood Head Injury. Asian J Neurosurg 2018; 13:681-684. [PMID: 30283526 PMCID: PMC6159040 DOI: 10.4103/ajns.ajns_164_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Epidural hematoma (EDH) is a traumatic accumulation of blood between the inner table of the skull and the stripped off dural membrane and predominantly consists of venous blood in infants. The study aims to assess the outcome of pediatric EDH using King's Outcome Scale for Childhood Head Injury (KOSCHI). Materials and Methods: A total of 72 patients’ files were reviewed retrospectively with a diagnosis of EDH from January 2012 to December 2014. Predesigned proforma was filled using data from patient records. In addition, KOSCHI was calculated using recent telephone interviews. Results: Among 72 patients, 65.3% were male and 34.7% were female. Overall, road traffic accident was the most common cause (52.8%) followed by fall, assault, and sports injury. The most common symptom was more than two episodes of vomiting which was present in 51.4% of patients followed by loss of consciousness in 37.5%, ENT bleed in 33.3%, headache in 16.7%, and fits in 11.1% of patients. The median follow-up of our patients was 19 (6–40) months. Most of our patients made good recovery with 76.4% of our patients scoring 5b on KOSCHI. Conclusion: EDH is not uncommon among children with head injury. It should be suspected in every child with posttraumatic skull fracture or scalp hematoma. Prompt surgical intervention can give good long-term outcome.
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Affiliation(s)
- Muhammad Sohail Umerani
- Department of Neurosurgery, King Fahd Military Medical Complex, Dammam, Saudi Arabia.,Department of Neurosurgery, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Asad Abbas
- Department of Neurosurgery, Liaquat National Hospital and Medical College, Karachi, Pakistan.,Department of Neurosurgery, Jinnah Post Graduate Medical Center, Karachi, Pakistan
| | - Fatima Aziz
- Department of Neurosurgery, Jinnah Post Graduate Medical Center, Karachi, Pakistan
| | - Rafiya Shahid
- Department of Neurosurgery, Jinnah Post Graduate Medical Center, Karachi, Pakistan
| | - Faiza Ali
- Department of Neurosurgery, Jinnah Post Graduate Medical Center, Karachi, Pakistan
| | - Raza Khairat Rizvi
- Department of Neurosurgery, Jinnah Post Graduate Medical Center, Karachi, Pakistan
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Rabelo NN, Matushita H, Cardeal DD. Traumatic brain lesions in newborns. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:180-188. [PMID: 28355327 DOI: 10.1590/0004-282x20170016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 12/08/2016] [Indexed: 11/22/2022]
Abstract
Methods A literature review using the PubMed data base, MEDLINE, EMBASE, Science Direct, The Cochrane Database, Google Scholar, and clinical trials. Selected papers from 1922 to 2016 were studied. We selected 109 papers, through key-words, with inclusion and exclusion criteria. Discussion This paper discusses the risk factors for birth trauma, the anatomy of the occipito-anterior and vertex presentation, and traumatic brain lesions. Conclusion Birth-related traumatic brain injury may cause serious complications in newborn infants. Its successful management includes special training, teamwork, and an individual approach.
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Affiliation(s)
- Nícollas Nunes Rabelo
- Hospital Santa Casa de Ribeirão Preto. Departamento de Neurocirurgia, Ribeirão Preto SP, Brasil
| | - Hamilton Matushita
- Universidade de São Paulo. Divisão de Neurocirurgia Pediátrica, Faculdade de Medicina, São Paulo SP, Brasil
| | - Daniel Dante Cardeal
- Universidade de São Paulo. Divisão de Neurocirurgia Pediátrica, Faculdade de Medicina, São Paulo SP, Brasil
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Pereira RDB, Silva TME, Quadros AAJ, Orsini M, Schmidt B, Silva HCA, Oliveira ASB. Assessment of energy expenditure in individuals with post-poliomyelitis syndrome. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:147-152. [PMID: 28355321 DOI: 10.1590/0004-282x20170013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 11/21/2016] [Indexed: 11/22/2022]
Abstract
Methods The Baecke questionnaire for the evaluation of habitual physical activity (HPA), assessment of quality of life (WHOQOL-Bref), and the Fatigue Severity Scale were administered to patients with PPS, poliomyelitis sequelae (PS) and to a control group (CG). Participated in the study 116 individuals (PPS=52,PS= 28,CG=36). Results Patients with PPS tended to increase their HPA from 10 to 20 years of age, compared with those in the PS group and the CG. In the period from 21 to 30 years of age, there was significant increase in the PPS group's occupational physical activity compared to the PS group, and the occupational physical activity (21-30 years of age) correlated with the onset of symptoms of PPS. Conclusion Patients with PPS had a higher energy expenditure during life, especially in occupational physical activity at ages 21-30 years, suggesting this decade is critical for the development of PPS.
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Affiliation(s)
| | - Tatiana Mesquita E Silva
- Universidade Federal de São Paulo, Setor de Investigação nas Doenças Neuromusculares, São Paulo SP, Brasil
| | | | - Marco Orsini
- Centro Universitário Augusto Motta, Mestrado em Ciências da Reabilitação, Bonsucesso RJ, Brasil.,Universidade Severino Sombra, Mestrado em Ciências Aplicadas a Saúde, Vassouras RJ, Brasil
| | - Beny Schmidt
- Universidade Federal de São Paulo, Setor de Investigação nas Doenças Neuromusculares, São Paulo SP, Brasil
| | | | - Acary Souza Bulle Oliveira
- Universidade Federal de São Paulo, Setor de Investigação nas Doenças Neuromusculares, São Paulo SP, Brasil
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Kiessling JW, Hertzler DA, Drucker DE, Spader HS. Traumatic Frontal Epidural Hematoma Caused by Multiple Arterial Injuries in the Anterior Fossa. World Neurosurg 2017; 97:757.e19-757.e23. [DOI: 10.1016/j.wneu.2016.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/30/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
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Nath PC, Mishra SS, Das S, Deo RC. Supratentorial extradural hematoma in children: An institutional clinical experience of 65 cases. J Pediatr Neurosci 2015; 10:114-8. [PMID: 26167211 PMCID: PMC4489051 DOI: 10.4103/1817-1745.159192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim and Objective: To survey the epidemiology, management, and severity of extradural hematoma (EDH) in children. Materials and Methods: All patients of EDH (n = 65) in the age group of 0–16 years admitted to our department during the period of August 13 and July 14 were analyzed retrospectively from the hospital records. In all patients, age, sex, mode of injury, clinical presentation, site of EDH, management, duration of hospitalization, and outcome were evaluated. Observation and Results: Of 65 patients, males were 70.76% with a male to female ratio of 2.4:1, most of the victims (47.69%) were in the age group of 11–16 years. Mean duration of hospitalization was 4.32 days. The most common mode of injury was fall from height in 29 cases (44.61%) followed by road traffic accident (RTA) in 23 cases (35.35%). Temporoparietal EDH was the most common computed tomography finding present in 22 (33.84%) patients. 67.69% patients presented to casualty with minor head injury having Glasgow coma scale (GCS) between 14 and 15. Most common presenting feature was vomiting in 52 cases (80%) and next to it was altered sensorium. The mortality rate was 7.69% (n = 5). Conclusion: Extradural hematoma is a life-threatening entity encountered in pediatric head injury. Timely intervention and diagnosis decrease mortality to a great degree. Most of the mortality is encountered in patients who presented late at the neurosurgical unit with low GCS.
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Affiliation(s)
| | | | - Srikant Das
- Department of Neurosurgery, SCB Medical College, Cuttack, Odisha, India
| | - Rama Chandra Deo
- Department of Neurosurgery, SCB Medical College, Cuttack, Odisha, India
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Khan MB, Riaz M, Javed G, Hashmi FA, Sanaullah M, Ahmed SI. Surgical management of traumatic extra dural hematoma in children: Experiences and analysis from 24 consecutively treated patients in a developing country. Surg Neurol Int 2013; 4:103. [PMID: 24032078 PMCID: PMC3766325 DOI: 10.4103/2152-7806.116425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 07/01/2013] [Indexed: 11/21/2022] Open
Abstract
Background: Children with epidural hematoma (EDH) present differently than adults. The outcome of treatment is also different. We aim to report our experiences with EDH in pediatric age group in terms of mode of injury, presenting features, management, and outcomes. We also aim to identify different prognostic indicators in pediatric patients with EDH. Methods: We prospectively collected data from 24 consecutively surgically treated pediatric patients. The data collected included presenting features, radiological imaging, details of management, and outcomes. Descriptive analysis was performed and different variables were tested for any statistical significance with Glasgow Outcome Score (GOS). Results: There were 19 male and 5 female patients. The mean Glasgow Coma Scale (GCS) score at presentation was 9.3 ± 4.4. Falls were the most common cause of EDH. Outcome assessment was done at 3 month follow up. A total of 15 patients had a GOS score of 5, 4 patients had a GOS score of 4, 2 patients had a GOS score of 3, while 3 patients had a GOS score of 1. On univariate analysis, admitting GCS score, patient's age, the time from injury to admission and injury to surgery, anisocoric pupils at presentation and effacement of basal cisterns were significantly associated with the outcome of GOS score. Conclusion: Falls are the most common mode of injury leading to EDH in children. Lower GCS at presentation, younger age at trauma, increased time since trauma to surgery and admission, anisocoria and effacement of basal cisterns are statistically significant variables in surgically treated pediatric patients of EDH that confer a poorer prognosis. A timely surgical intervention can result in excellent outcomes.
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Affiliation(s)
- Muhammad Babar Khan
- Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
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Skadorwa T, Zygańska E, Eibl M, Ciszek B. Distinct strategies in the treatment of epidural hematoma in children: clinical considerations. Pediatr Neurosurg 2013; 49:166-71. [PMID: 24732678 DOI: 10.1159/000359954] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 01/16/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Epidural hematoma (EDH) is the most common form of intracranial bleeding following head trauma in pediatric patients. It may develop into a life-threatening pathology, requiring an immediate neurosurgical intervention. However, due to an increasing number of posttrauma CT scans most pediatric EDH patients can be treated conservatively, because of minor dimensions of the clot and the possibility of quick control scanning. AIM Evaluation of distinct strategies in the treatment of EDH patients in our department between January 2007 and December 2012. RESULTS During this period a total number of 221 patients with EDH were enrolled in the study. Seventy-seven of them (35%) underwent surgical procedures. One hundred and forty-four patients (65%) were treated conservatively. The dominating age group among nonsurgical patients was 0-4 years (85 cases, 61% of the nonsurgical group). In most of these cases a small epidural blood collection with inconsiderable dynamics was observed. Twenty-one patients from this age group (20%) were treated operatively. Among older children (5-18 years) surgical treatment was implemented in 56 (49%) cases. CONCLUSIONS (1) EDH may be successfully treated conservatively with the use of control CT scans. (2) Smaller blood clots dominate in younger patients. (3) Surgical intervention is required more commonly in older patients.
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Affiliation(s)
- Tymon Skadorwa
- Department of Pediatric Neurosurgery, Bogdanowicz Memorial Hospital for Children, Warsaw, Poland
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Pan A, Li M, Gao JY, Xue ZQ, Li Z, Yuan XY, Luo DW, Luo XG, Yan XX. Experimental epidural hematoma causes cerebral infarction and activates neocortical glial and neuronal genesis in adult guinea pigs. J Neurosci Res 2012; 91:249-61. [DOI: 10.1002/jnr.23148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 08/26/2012] [Accepted: 09/02/2012] [Indexed: 12/16/2022]
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