Intracranial epidural hematoma in children: Epidemiology, anatomy and pathophysiology
- 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 — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical 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 the result of trauma. The morbidity and mortality result from mass effect on the brain as the hematoma grows and strips the dura away from the skull. EDH in children is managed similarly to adults, but it requires special knowledge of location and clinical presentation. Prompt diagnosis is critical to the successful management of EDH.
This topic discusses epidemiology, anatomy, and pathophysiology of EDH in children. Clinical features, evaluation, and management of EDH are presented separately. (See "Intracranial epidural hematoma in children: Clinical features, diagnosis, and management" and "Intracranial epidural hematoma in adults".)
Epidural hematoma (EDH) occurs infrequently among the large population of infants and children seen in emergency departments and physician offices for head trauma but is present in about 1 to 3 percent of pediatric closed head injury admissions [1-4]. There is a strong gender difference, with a 2 to 2.5:1 male predominance [4-6]. The etiology varies by age:
●EDH occurs rarely in neonates and is associated with delivery by forceps or vacuum extraction .
●In infancy and the intermediate childhood years, low velocity impact (such as falls) comprise the most common mechanism of injury [8-10]. Even falls less than 5 feet (1.5 m) may rarely result in EDH in this age group . Although intentional head injury in young children and infants typically causes subdural hematomas, child abuse accounts for 6 to 18 percent of EDH in case series [9,11]. (See "Child abuse: Epidemiology, mechanisms, and types of abusive head trauma in infants and children", section on 'Epidural hemorrhage' and "Intracranial subdural hematoma in children: Epidemiology, anatomy, and pathophysiology".)
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