Abstract

Background : Posterior fossa epidural hematoma rarely occurs in children after traumatic head injury. There is ongoing discussion about appropriate treatment, yet the radiological features regarding the time to resorption of the hematoma or required follow-up imaging are rarely discussed. Observations : We present the case of a 4-year-old child who was under clinical observation and receiving analgetic treatment in whom near-complete hematoma resorption was shown by brain CT scan imaging as soon as 24 hours after diagnosis. The child was neurologically stable at all times and showed no deficit after observational treatment. Hematoma resorption was much faster than expected. We discussed hematoma drainage via the sigmoid sinus. Conclusion: Epidural hematomas in children can be treated conservatively and are resorbed in a timely mannerthe moisture content as normal level they automatically dehumidifie the room area. Also it’s have auto regulator system.

Keywords

Introduction

Posterior fossa epidural hematoma (PFEDH) rarely occurs in children after traumatic head injury and comprises 5% of epidural hematomas (EDHs) in children. Incidence has become slightly higher, mostly because of more sensitive radiological diagnostics (1). Especially in cases of venous hematoma of the posterior fossa, there is ongoing discussion as to whether surgery or observation is the appropriate treatment. Few reports describe the time to resorption in conservatively treated cases or give recommendations concerning the timing of follow-up imaging.

Illustrative Case

A 4-year-old boy was admitted to the emergency department after an occipital trauma due to a fall down the stairs, with a history of initial loss of consciousness. Upon admission, the clinical examination revealed a fully conscious child, hemodynamically and respiratorily stable, with equal and reactive pupils, moderate headaches, and no sensory-motor deficits. He underwent a brain scan 4 hours after the trauma, which revealed a posterior fossa epidural hematoma (PFEDH) of 13 mL, associated with a right-sided occipital fracture extending towards the right transverse sinus, which remains patent. This hematoma exerts a mass effect on the left cerebellar hemisphere as well as on the collapsed fourth ventricle, without affecting the ventricular system upstream.(Fig. 1) Due to the suspected venous genesis of the bleeding, with oozing from a lesion in the transverse sinus, and considering the stable neurological state, an observational approach was chosen.  The child remained neurologically unchanged. No additional neurological deficit occurred.

       
           
       
Figure.1 CT scan approximately 4 hours after initial trauma (A) and (B) Bone window showing an occipital fracture extending to the left transverse sinus. (C)Axial CTand Sagittal (D) showing the left occipital PFEDH, Volume:13 cm3.

After the initial scan, the child underwent a follow-up scan 8 hours after the trauma, which showed spontaneous resorption with a reduction in the hematoma volume from 13 mL to 5 mL. (Fig. 2)

       
           
       
Figure.2. CT scan approximately 8 hours after initial trauma (A) Axial CTand Sagittal (B) showing almost complete resolution of the hematoma

After 24 hours of monitoring following the trauma, another brain scan was performed, showing complete resorption of the hematoma and the child was discharged from the hospital after an additional 48 hours of observation. (Fig. 3)

       
           
       
FIG. 3. CT scan approximately 24 hours after initial trauma (A) Axial CT showing almost complete resolution of the hematoma.

DISCUSSION

EDH is a well-known sequela of blunt trauma to the head in children. PFEDH comprises <10>

CONCLUSION

Through the imaging presented here, the resorption of the hematoma can be quite rapid and nearly complete. Regardless of the duration of resorption, observational treatment remains a valid option in cases of pediatric venous PFEDH. In this specific case, the potential surgical risk and trauma outweighed the short period of hematoma presence. The observations and conclusions in this case are limited by its unique character and the specific location behind the transverse sinus. Furthermore, rapid resorption does not justify observational treatment in cases of neurologically symptomatic hematoma. In any case, regardless of how quickly the hematoma is reabsorbed, surgical evacuation should always be favored in cases with neurological deficits, as it is generally faster in all cases.

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