Case: 6-year-old Girl Hits Her Head

00:00 In this talk, let's discuss epidural hemorrhage.

00:05 And let's start with a case.

00:07 This is a young 6 year-old girl in her normal state of health, who was sledding in the snow with friends when she was struck from standing by a sled and falls onto the ground hitting her head.

00:19 After being a bit confused on the ground, she stands up and appears normal.

00:23 She's taken home to rest and watched closely by her parents.

00:28 Several hours later, the patient becomes increasingly sleepy.

00:32 She's taken to the emergency department, where she somnolent, difficult to arouse, has right hemibody weakness that withdraws only with pain and a CT of the head is performed.

00:43 So when you think about this case, there are a number of key features here.

00:46 First is the traumatic event, which is the nidus for this presentation.

00:51 And then there's this appearance of a lucid interval, an initial period of confusion, followed by normalization and then progressive neurologic decline.

01:00 And in terms of localization, she has a focal neurologic presentation with right hemibody weakness suggesting a left cortical left hemispheric problem.

01:11 So let's look at the imaging.

01:12 A noncontrast head CT was performed and demonstrated this lesion at the back and base of the brain behind the cerebellum.

01:20 There is this lens-shape, hyper density, extra axially outside of the brain.

01:28 So what's the most likely diagnosis? Is this an epidural hematoma, subdural hematoma, concussion or mild TBI or an intraparenchymal hemorrhage? Well, this isn't the imaging appearance of a subdural hematoma, subdurals are crescent-shaped lesions that extend beyond suture lines of the brain.

01:47 It's more common in older individuals, we can see it in young individuals, and it typically progress presents with a steady and gradual progression of symptoms.

01:58 This isn't the appearance of an intraparenchymal hemorrhage, the blood here is outside of the brain and not within the parenchyma proper.

02:05 And so this is inconsistent with IPH at least what we've seen thus far.

02:10 This is not the presentation of a mild TBI.

02:13 The patient has significant neurologic deficits intracranial hemorrhage, and so this is inconsistent with mild TBI or concussion.

02:22 And this is a typical presentation of a patient with an epidural hematoma both the clinical presentation and the imaging findings.