EXTRADURAL HEMATOMAS IN CHILDREN

Objective. To determine the cause, clinical presentation, radiological and computed tomography (CT) findings, anatomical position and post-s urgical outcome of traumatic intracranial, extradural haemorrhage in c hildren, Design. Retrospective study, 1979 - 1994. Setting. Neurosurgi cal referrals from the Trauma Unit at Red Cross War Memorial Children' s Hospital, Cape Town. Participants, Forty-four children below the age of 12 years who had extradural haematomas surgically removed. Results . Twenty-one extradural haematomas resulted from falls, 12 from motor vehicle accidents, and 6 from assaults; 1 was of unknown cause, Ninete en patients presented with persistent drowsiness (14/15 on the Glasgow Coma Scale), 17 had headache and vomiting, and 13 gave a history of i nitial loss of consciousness. Seventeen pre-operative neurological exa minations were, normal, 11 showed anisocoria, 10 hemiplegia, 4 ataxia, 1 nystagmus and 1 a full fontanelle, Cases of posterior fossa haemato ma presented with headache and ataxia. Skull fractures were visible on radiographs in 26; computed tomographic diagnosis was made in all but 1. The site of extradural haematoma was parieto-occipital in 24, post erior fossa in 17, frontal in 6, and temporal in 3. Subdural haematoma s occurred in 4 cases, Surgical treatment consisted of 41 craniotomies /craniectomies acid 3 burr-holes. Postoperatively 36 patients were neu rologically normal, 6 had neurological deficits, and 2 died. Conclusio n. Intracranial extradural haemorrhage in children presents in an atyp ical manner when compared with adults. An initial loss of consciousnes s followed by a lucid interval and a progressive deteriorating level o f consciousness is the exception rather than the rule, Timeous neurosu rgical treatment resulted in an excellent outcome in 36 of the 44 chil dren.