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".)
- Choux M, Lena G, Genitori L. Intracranial hematomas. In: Head Injuries in the Newborn and Infant, Raimondi A, Choux M, DiRocco C (Eds), Springer-Verlag Inc, New York 1986. p.204.
- Kim KA, Wang MY, Griffith PM, et al. Analysis of pediatric head injury from falls. Neurosurg Focus 2000; 8:e3.
- Obana WG, Pitts LH. Management of head injury. Extracerebral lesions. Neurosurg Clin N Am 1991; 2:351.
- Rocchi G, Caroli E, Raco A, et al. Traumatic epidural hematoma in children. J Child Neurol 2005; 20:569.
- Erşahin Y, Mutluer S, Güzelbag E. Extradural hematoma: analysis of 146 cases. Childs Nerv Syst 1993; 9:96.
- Paşaoğlu A, Orhon C, Koç K, et al. Traumatic extradural haematomas in pediatric age group. Acta Neurochir (Wien) 1990; 106:136.
- Noetzel MJ. Perinatal trauma and cerebral palsy. Clin Perinatol 2006; 33:355.
- Aronyk KE. Post-traumatic hematomas. In: Pediatric Neurosurgery: Surgery of the Developing Nervous System, Cheek WR, Marlin AE, McLone DG, et al (Eds), WB Mason, Philadelphia 1994. p.279.
- Ciurea AV, Kapsalaki EZ, Coman TC, et al. Supratentorial epidural hematoma of traumatic etiology in infants. Childs Nerv Syst 2007; 23:335.
- Schutzman SA, Barnes PD, Mantello M, Scott RM. Epidural hematomas in children. Ann Emerg Med 1993; 22:535.
- Wells RG, Vetter C, Laud P. Intracranial hemorrhage in children younger than 3 years: prediction of intent. Arch Pediatr Adolesc Med 2002; 156:252.
- Pillay R, Peter JC. Extradural haematomas in children. S Afr Med J 1995; 85:672.
- Gallagher JP, Browder EJ. Extradural hematoma. Experience with 167 patients. J Neurosurg 1968; 29:1.
- Jamjoom A, Cummins B, Jamjoom ZA. Clinical characteristics of traumatic extradural hematoma: a comparison between children and adults. Neurosurg Rev 1994; 17:277.
- Choux M, Grisoli F, Peragut JC. Extradural hematomas in children. 104 cases. Childs Brain 1975; 1:337.
- Ammirati M, Tomita T. Posterior fossa epidural hematoma during childhood. Neurosurgery 1984; 14:541.
- Mohanty A, Kolluri VR, Subbakrishna DK, et al. Prognosis of extradural haematomas in children. Pediatr Neurosurg 1995; 23:57.
- Allen CH, Ward JD. An evidence-based approach to management of increased intracranial pressure. Crit Care Clin 1998; 14:485.
- Monro A. Observations on the Structure and Functions of the Nervous System, Creech and Johnson, Edinburgh 1783.
- Kellie, G . An account of the appearances observed in the dissection of two of the individuals presumed to have perished in the storm of the third, and whose bodies were discovered in the vicinity of Leith on the morning of the 4th November 1821; with some reflections on the pathology of the brain. Trans Med Chir Soc (Edinburgh) 1821- 1832; 1:84.
- Steele DW. Neurosurgical emergencies, nontraumatic. In: Textbook of Pediatric Emergency Medicine, 5th, Fleisher GR, Ludwig S, Henretig FM (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.1717.
- Poss WB, Brockmeyere DL, Clay B, Dean JM. Pathophysiology and management of the intracranial vault. In: Textbook of Pediatric Intensive Care, Rogers MC (Ed), Williams & Wilkins, Baltimore 1996. p.645.
- Greenes DS. Neurotrauma. In: Textbook of Pediatric Emergency Medicine, 5th, Fleisher GR, Ludwig S, Henretig FM (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.1361.
- Borovich B, Braun J, Guilburd JN, et al. Delayed onset of traumatic extradural hematoma. J Neurosurg 1985; 63:30.
- Jaimovich, R, Monges, JA . Delayed posttraumatic intracranial lesions in children. Pediatr Neurosurg 1991- 1992; 17:25.
- Piepmeier JM, Wagner FC Jr. Delayed post-traumatic extracerebral hematomas. J Trauma 1982; 22:455.
- Summers LE, Mascott CR. Delayed epidural hematoma: presentation in a pediatric patient. J La State Med Soc 2001; 153:81.
- Bullock R, Hanemann CO, Murray L, Teasdale GM. Recurrent hematomas following craniotomy for traumatic intracranial mass. J Neurosurg 1990; 72:9.
- Feuerman T, Wackym PA, Gade GF, et al. Intraoperative development of contralateral epidural hematoma during evacuation of traumatic extraaxial hematoma. Neurosurgery 1988; 23:480.
- Griffiths SJ, Jatavallabhula NS, Mitchell RD. Spontaneous extradural haematoma associated with craniofacial infections: case report and review of the literature. Br J Neurosurg 2002; 16:188.
- Fujimoto Y, Aguiar PH, Carneiro JD, et al. Spontaneous epidural hematoma following a shunt in an infant with congenital factor X deficiency. Case report and literature review. Neurosurg Rev 1999; 22:226.
- Chen HC, Shen WC, Chou DY, Chiang IP. Langerhans cell histiocytosis of the skull complicated with an epidural hematoma. AJNR Am J Neuroradiol 2002; 23:493.
- Naran AD, Fontana L. Sickle cell disease with orbital infarction and epidural hematoma. Pediatr Radiol 2001; 31:257.