Liquid Posterior Fossa Epidural Hematoma in Pediatric Trauma: A Single-Center Case Series

Abstract

Background Liquid posterior fossa epidural hematoma (LPFEH) following head trauma is uncommon, and very few such cases have been described in the literature. Eight patients with this entity and their treatments are presented here.

Methods We performed a single-institution retrospective analysis of all patients with diagnosed LPFEH over a 3-year period. Collected data included clinical history, laboratory results, treatment, and review of all imaging studies performed.

Results Eight pediatric cases were identified with imaging findings consistent with LPFEH; no adult case was identified. Enlargement of ventricles appeared on computed tomography (CT) in six cases, and secondary epilepsy onset occurred in three cases with severe dilated ventricles. Routine hematologic and coagulation tests failed to disclose anemia or abnormal coagulation in each case. Five patients underwent burr-hole drainage of the hematoma and recovered completely. Conservative therapy was adopted in three patients for small hematomas, and hematoma enlargement was not observed in the follow-up CT scans.

Conclusions LPFEH is a rare subtype of traumatic epidural hematoma specifically recognized in the pediatric population. Minimally invasive burr-hole drainage is a feasible procedure for the patient with evident space-occupying effect. Coagulation dysfunction or low hemoglobin as a possible contributing factor and its role in formation of LPFEH was excluded.

Keywords

computed tomography - pediatric - epidural hematoma - liquid - posterior fossa

• References

• 1 Singh S, Ramakrishnaiah RH, Hegde SV, Glasier CM. Compression of the posterior fossa venous sinuses by epidural hemorrhage simulating venous sinus thrombosis: CT and MR findings. Pediatr Radiol 2016; 46 (01) 67-72
• 2 Hu TT, Yan L, Yan PF, Wang X, Yue GF. Assessment of the ABC/2 method of epidural hematoma volume measurement as compared to computer-assisted planimetric analysis. Biol Res Nurs 2016; 18 (01) 5-11
• 3 Prasad GL, Gupta DK, Sharma BS, Mahapatra AK. Traumatic pediatric posterior fossa extradural hematomas: a tertiary-care trauma center experience from India. Pediatr Neurosurg 2015; 50 (05) 250-256
• 4 Mahajan RK, Sharma BS, Khosla VK. Liquid acute epidural hematoma. Indian Pediatr 1993; 30 (01) 100-102
• 5 Bergström M, Ericson K, Levander B, Svendsen P, Larsson S. Variation with time of the attenuation values of intracranial hematomas. J Comput Assist Tomogr 1977; 1 (01) 57-63
• 6 New PF, Aronow S. Attenuation measurements of whole blood and blood fractions in computed tomography. Radiology 1976; 121 (3 Pt. 1): 635-640
• 7 Aoki N. Epidural haematoma in the newborn infants: therapeutic consequences from the correlation between haematoma content and computed tomography features. A review. Acta Neurochir (Wien) 1990; 106 (1–2): 65-67
• 8 Arrese I, Lobato RD, Gomez PA, Nuñez AP. Hyperacute epidural haematoma isodense with the brain on computed tomography. Acta Neurochir (Wien) 2004; 146 (02) 193-194
• 9 Chee CP, Habib ZA. Hypodense bubbles in acute extradural haematomas following venous sinus tear. A CT scan appearance. Neuroradiology 1991; 33 (02) 152-154
• 10 Greenberg J, Cohen WA, Cooper PR. The “hyperacute” extraaxial intracranial hematoma: computed tomographic findings and clinical significance. Neurosurgery 1985; 17 (01) 48-56
• 11 Higashi K, Tanaka T, Miyawaki M. Extradural hematoma with liquid content [in Japanese]. No To Shinkei 1968; 20 (10) 1005-1010
• 12 Iplikcioğlu AC, Ozer F, Benli K, Kutluk T, Gürçay O. Liquid extradural hematoma with congenital fibrinogen deficiency. Case report. Surg Neurol 1988; 30 (03) 228-230
• 13 Suzuki S, Endo M, Kurata A. , et al. Efficacy of endovascular surgery for the treatment of acute epidural hematomas. AJNR Am J Neuroradiol 2004; 25 (07) 1177-1180
• 14 Yilmazlar S, Kocaeli H, Dogan S. , et al. Traumatic epidural haematomas of nonarterial origin: analysis of 30 consecutive cases. Acta Neurochir (Wien) 2005; 147 (12) 1241-1248 ; discussion 1248
• 15 Habibi Z, Meybodi AT, Haji Mirsadeghi SM, Miri SM. Burr-hole drainage for the treatment of acute epidural hematoma in coagulopathic patients: a report of eight cases. J Neurotrauma 2012; 29 (11) 2103-2107
• 16 Liu JT, Tyan YS, Lee YK, Wang JT. Emergency management of epidural haematoma through burr hole evacuation and drainage. A preliminary report. Acta Neurochir (Wien) 2006; 148 (03) 313-317 ; discussion 317
• 17 Liu W, Ma L, Wen L. , et al. Drilling skull plus injection of urokinase in the treatment of epidural haematoma: a preliminary study. Brain Inj 2008; 22 (02) 199-204