Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Intracranial epidural hematoma in children: Clinical features, diagnosis, and management

Edward S Ahn, MD
Mark R Proctor, MD
Section Editor
Richard G Bachur, MD
Deputy Editor
James F Wiley, II, MD, MPH


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'.)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Dec 10, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Neely JC 2nd, Jones BV, Crone KR. Spontaneous extracranial decompression of epidural hematoma. Pediatr Radiol 2008; 38:316.
  2. Chida K, Yukawa H, Mase T, et al. Spontaneous slow drainage of epidural hematoma into the subgaleal space through a skull fracture in an infant--case report. Neurol Med Chir (Tokyo) 2011; 51:854.
  3. Ciurea AV, Nuteanu L, Simionescu N, Georgescu S. Posterior fossa extradural hematomas in children: report of nine cases. Childs Nerv Syst 1993; 9:224.
  4. Beni-Adani L, Flores I, Spektor S, et al. Epidural hematoma in infants: a different entity? J Trauma 1999; 46:306.
  5. Heyman R, Heckly A, Magagi J, et al. Intracranial epidural hematoma in newborn infants: clinical study of 15 cases. Neurosurgery 2005; 57:924.
  6. Rocchi G, Caroli E, Raco A, et al. Traumatic epidural hematoma in children. J Child Neurol 2005; 20:569.
  7. Peter JC, Domingo Z. Subacute traumatic extradural haematomas of the posterior fossa: a clinicopathological entity of the 5- to 10-year-old child. Childs Nerv Syst 1990; 6:135.
  8. Erşahin Y, Mutluer S, Güzelbag E. Extradural hematoma: analysis of 146 cases. Childs Nerv Syst 1993; 9:96.
  9. Paşaoğlu A, Orhon C, Koç K, et al. Traumatic extradural haematomas in pediatric age group. Acta Neurochir (Wien) 1990; 106:136.
  10. Pillay R, Peter JC. Extradural haematomas in children. S Afr Med J 1995; 85:672.
  11. Choux M, Grisoli F, Peragut JC. Extradural hematomas in children. 104 cases. Childs Brain 1975; 1:337.
  12. Berker M, Cataltepe O, Ozcan OE. Traumatic epidural haematoma of the posterior fossa in childhood: 16 new cases and a review of the literature. Br J Neurosurg 2003; 17:226.
  13. Vinchon M, Pierrat V, Tchofo PJ, et al. Traumatic intracranial hemorrhage in newborns. Childs Nerv Syst 2005; 21:1042.
  14. Bozbuğa M, Izgi N, Polat G, Gürel I. Posterior fossa epidural hematomas: observations on a series of 73 cases. Neurosurg Rev 1999; 22:34.
  15. Malik NK, Makhdoomi R, Indira B, et al. Posterior fossa extradural hematoma: our experience and review of the literature. Surg Neurol 2007; 68:155.
  16. Duffy GP. Lumbar puncture in the presence of raised intracranial pressure. Br Med J 1969; 1:407.
  17. Ammirati M, Tomita T. Posterior fossa epidural hematoma during childhood. Neurosurgery 1984; 14:541.
  18. Neubauer UJ. Extradural haematoma of the posterior fossa. Twelve years experiences with CT-scan. Acta Neurochir (Wien) 1987; 87:105.
  19. Osborne AG. Craniocerebral trauma. In: Diagnostic Neuroradiology, Mosby, St. Louis 1994. p.199.
  20. Gentry LR, Godersky JC, Thompson B, Dunn VD. Prospective comparative study of intermediate-field MR and CT in the evaluation of closed head trauma. AJR Am J Roentgenol 1988; 150:673.
  21. Miller DJ, Steinmetz M, McCutcheon IE. Vertex epidural hematoma: surgical versus conservative management: two case reports and review of the literature. Neurosurgery 1999; 45:621.
  22. Victor M, Ropper A. Craniocerebral trauma. In: Adams and Victor's Principles of Neurology, 7th, Victor M, Ropper A. (Eds), McGraw-Hill, New York 2001. p.925.
  23. Schutzman SA, Barnes PD, Mantello M, Scott RM. Epidural hematomas in children. Ann Emerg Med 1993; 22:535.
  24. Jamjoom A, Cummins B, Jamjoom ZA. Clinical characteristics of traumatic extradural hematoma: a comparison between children and adults. Neurosurg Rev 1994; 17:277.
  25. Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of acute epidural hematomas. Neurosurgery 2006; 58:S7.
  26. Bejjani GK, Donahue DJ, Rusin J, Broemeling LD. Radiological and clinical criteria for the management of epidural hematomas in children. Pediatr Neurosurg 1996; 25:302.
  27. Balmer B, Boltshauser E, Altermatt S, Gobet R. Conservative management of significant epidural haematomas in children. Childs Nerv Syst 2006; 22:363.
  28. Givner A, Gurney J, O'Connor D, et al. Reimaging in pediatric neurotrauma: factors associated with progression of intracranial injury. J Pediatr Surg 2002; 37:381.
  29. Pang D, Horton JA, Herron JM, et al. Nonsurgical management of extradural hematomas in children. J Neurosurg 1983; 59:958.
  30. Kawakami Y, Tamiya T, Tanimoto T, et al. Nonsurgical treatment of posterior fossa epidural hematoma. Pediatr Neurol 1990; 6:112.
  31. Gerlach R, Dittrich S, Schneider W, et al. Traumatic epidural hematomas in children and adolescents: outcome analysis in 39 consecutive unselected cases. Pediatr Emerg Care 2009; 25:164.