SPONTANEOUS RAPID RESOLUTION OF AN EPIDURAL HEMATOMA ASSOCIATED WITH AN OVERLYING SKULL FRACTURE AND SUBGALEAL HEMATOMA IN A 17-MONTH-OLD CHILD

Acute traumatic epidural hematomas (EDH) constitute one of the most cr itical emergencies in neurosurgical management, The rapid spontaneous resolution (<24 h) of EDH is an extremely rare phenomenon, A 17-month- old patient fell from a height of 1.5 m and presented with a 8-mm temp oral EDH, an overlying linear skull fracture, and a subgaleal hematoma without evidence of intraparenchymal injury or edema. The patient com plained only of mild headache, harbored no neurological deficits, and was, therefore, managed conservatively in the intensive care unit with provision to proceed to surgical decompression in the event of neurol ogical change, A repeat CT study 18 h later revealed near-complete res olution of the EDH with a coincident increase in the volume and spread of the subgaleal hematoma, This is the fourth reported case of rapid spontaneously resolving EDH and the youngest one to date. All 4 cases have coincided with an overlying linear skull fracture, We propose tha t unlike classical EDH, rapidly resolving EDH in the absence of elevat ed intracranial pressure (ICP) originates from elevated interstitial p ressure in the subgaleal compartment transiently decompressing into th e epidural space through a skull fracture and resolving as the pressur e in the subgaleal compartment decreases below ICP.