Intracranial epidural hematoma in children: Clinical features, diagnosis, and management
- Edward S Ahn, MD
Edward S Ahn, MD
- Associate Professor of Neurosurgery
- Johns Hopkins University School of Medicine
- Mark R Proctor, MD
Mark R Proctor, MD
- Associate Professor of Neurosurgery
- Harvard Medical School
- Section Editor
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Epidural hematoma (EDH), also known as extradural hematoma, is a hemorrhage into the space between the dura and the overlying calvarium. It is almost exclusively caused by trauma. The morbidity and mortality result from mass effect on the brain as the hematoma expands and strips the dura away from the skull. EDH in children requires special knowledge of location and clinical presentation. Prompt diagnosis and neurosurgical consultation is critical to the successful management of EDH.
This topic discusses the clinical features, diagnosis, and management of EDH in children. Epidemiology, anatomy, and pathophysiology of EDH in children as well as EDH in adults are presented separately. (See "Intracranial epidural hematoma in children: Epidemiology, anatomy and pathophysiology" and "Intracranial epidural hematoma in adults".)
A rapid overview provides the clinical features, diagnostic evaluation, and emergent management for epidural hematomas in children (table 1).
Concerning history — Historical features that identify an increased risk of EDH include the following:
●High risk trauma mechanism – A high risk trauma mechanism, such as fall from a significant height (>10 feet or two to three times the child’s height), any mechanism involving a motor vehicle, or direct blow to the temporal or occipital region should raise concern for EDH, even in initially well-appearing children. Of note, even relatively minor mechanisms of head injury in young infants can cause serious traumatic brain injury, including EDH. The evaluation of minor head trauma in such patients is discussed in detail separately. (See "Minor head trauma in infants and children: Evaluation", section on 'Younger than two years'.)
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- CLINICAL FEATURES
- Concerning history
- Findings by age
- - Infants
- - Older children
- Temporal skull injury with a lucid interval
- Occipital injury
- ANCILLARY STUDIES
- Laboratory studies
- Radiographic imaging
- - Cervical spine imaging
- - Computed tomography (CT)
- - Other imaging
- INITIAL MANAGEMENT
- Initial assessment and treatment
- Neurosurgical consultation
- DEFINITIVE MANAGEMENT
- Operative treatment
- - Clinical criteria
- - Radiographic criteria
- Surgical procedure
- Nonoperative treatment
- Posterior fossa epidural hematoma
- FOLLOW-UP AND RECOVERY
- Operative patients
- Nonoperative patients
- SUMMARY AND RECOMMENDATIONS