1
|
Lim CC, Saniasiaya J, Kulasegarah J. Postauricular swelling secondary to salmonella extradural abscess in a toddler: a near miss condition. BMJ Case Rep 2021; 14:e243412. [PMID: 34210704 PMCID: PMC8252683 DOI: 10.1136/bcr-2021-243412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2021] [Indexed: 11/03/2022] Open
Abstract
Postauricular swelling is usually encountered in an emergency setting in otorhinolaryngology, resulting from complication of acute or chronic suppurative otitis media. Besides that, postauricular swelling may occur secondary to various other conditions including infectious disease, tumour, vascular malformation, granulomatous condition and even trauma. Children less than 2 years old are prone to fall and up to 10% sustain traumatic brain injury without any obvious signs of neurological deficit. We describe a rare case of a postauricular swelling in a toddler which turned out to be salmonella extradural abscess from an infected traumatic haematoma. The importance of high clinical suspicion especially in a child with a history of fall cannot be emphasised more because a missed brain abscess could lead to potentially life-threatening problems. We would like to highlight that meticulous history taking along with prompt assessment and intervention is prudent for a better prognosis and recovery.
Collapse
Affiliation(s)
- Chee Chean Lim
- Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jeyasakthy Saniasiaya
- Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jeyanthi Kulasegarah
- Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
2
|
Sobti S, Goyari M, Harpanahalli R, Gupta LN, Choudhary A, Taneja A. Clinico-radiological Correlation with Outcome in Traumatic Pediatric Extradural Hematoma: A Single Institutional Experience. J Pediatr Neurosci 2021; 16:113-118. [PMID: 35018178 PMCID: PMC8706599 DOI: 10.4103/jpn.jpn_61_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/29/2020] [Accepted: 08/27/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Head injury is one of the leading causes of mortality and morbidity in the developing as well as developed countries. Extradural hematoma is seen in 1-2% of cases of head injury patients. Extradural hematoma is infrequent in the pediatric age group (less than 18 years) as duramater is tightly adherent to the inner table of the skull and is present in about 1-3% of all pediatric head injuries. MATERIALS AND METHODS The study was a prospective study conducted in the Department of Neurosurgery at PGIMER, Dr. RML Hospital, New Delhi, over a period of 19 months with a follow-up of 6 months. In total, 38 patients were enrolled in the study. All traumatic extradural hematoma below 18 years of age of both sexes were included. Follow-up of all patients was done at 2 weeks, 1, 2, and 6 months. Noncontrast computed tomography (NCCT) head was done in all patients at the time of admission and whenever their neurological status deteriorated. Routine postoperative NCCT head was done. Outcome assessment was done by Glasgow outcome scale. RESULTS Of the 38 children, 21 were males and 17 were females. The maximum number of patients was between the ages of 1-5 years (55.26%). Fall from height was the most common cause. Loss of consciousness was the most common presenting symptom (78.94%). Thirty-three patients had GCS of 14-15 at the time of presentation. The parietal region was the most common location of EDH in our study (44.74%). Thirty-five patients had supratentorial and three patients had infratentorial EDH. Eighteen patients had associated brain injury, commonest being brain edema. Six patients were operated. There was no mortality in our study. Two patients had limb paresis. CONCLUSION Pediatric EDH is a rare entity but a potentially life-threatening condition. Prompt diagnosis and timely intervention decrease morbidity and mortality.
Collapse
Affiliation(s)
- Shivender Sobti
- Department of Neurosurgery, Dayanand Medical College & Hospital, Ludhiana
| | | | | | | | - Ajay Choudhary
- Department of Neurosurgery, ABVIMS & Dr. RML Hospital, New Delhi
| | - Anil Taneja
- Department of Radiology, ABVIMS & Dr. RML Hospital, New Delhi
| |
Collapse
|
3
|
Abstract
Delivery room emergencies due to birth injuries are serious, usually unexpected, and can be distressing situations that necessitate immediate action to reduce neonatal morbidity and prevent neonatal mortality. Birth injuries requiring immediate, urgent care in the delivery room are uncommon, hence knowledge of obstetric risk factors and prenatal conditions linked to birth injury is an important first step in the management of affected neonates. Furthermore, immediate recognition of injury and quick action upon delivery is essential in order to achieve the best possible outcomes. This chapter briefly reviews the known risk factors associated with birth injury, and then discusses the identification and management of specific injuries that may require immediate treatment in the delivery room, or hasty management within hours after birth.
Collapse
Affiliation(s)
- Tiffany McKee-Garrett
- Baylor College of Medicine, Department of Pediatrics, Section of Neonatology, Houston, TX, USA.
| |
Collapse
|
4
|
Abstract
Acute symptomatic seizures caused by either diffuse or focal perinatal hypoxic-ischemic insults and intracranial hemorrhage in term newborns make up the large majority of all neonatal seizures. Acute seizures are one of the most common neurological disorders in term newborns who require admission to the neonatal intensive care unit. Despite elucidation of seizure pathogenesis in this population using animal models, treatment is limited by a lack of good evidence-based guidelines because of a paucity of rigorously conducted clinical trials or prospective studies in human newborns. A result of this knowledge gap is that management, particularly drug choice, is guided by clinical experience rather than by data informing drug efficacy and safety. This review summarizes the common etiologies and pathogenesis of acute symptomatic seizures, and the current data informing their treatment, including potential novel drugs, together with a suggested treatment algorithm.
Collapse
Affiliation(s)
- Janet S. Soul
- Fetal–Neonatal Neurology Program, Boston Children’s Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA,Address: Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA. Tel.: +1 617-355-8994; fax: +1 617-730-0279. (J.S. Soul)
| |
Collapse
|
5
|
Sato R. Occult large epidural hemorrhage in a newborn infant after in-hospital fall. J Neonatal Perinatal Med 2018; 11:195-197. [PMID: 29843268 DOI: 10.3233/npm-181752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Management of newborn infants fell in-hospital is especially challenging given the limited signs and symptoms of intracranial hemorrhage in this age group. We present a case of a four day old well appearing newborn infant found to have a severe epidural hemorrhage requiring emergent surgical drainage. Development of imaging protocols for newborn infants suffering in-hospital falls need to consider the potential consequences of missing actionable intracranial hemorrhage when relying on clinical observation as a management strategy.
Collapse
Affiliation(s)
- Ray Sato
- Tacoma General Hospital, Tacoma, Washington and The MEDNAX Center for Research, Education and Quality, Sunrise, FL, USA
| |
Collapse
|
6
|
Gregorio-Hernández R, González-Valcarcel M, Escobar-Izquierdo AB, López-Lozano Y, Cabada-Del Río A. Neonatal epidural haematoma. Presentation of 3 cases and a literature review. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
7
|
Brackmann F, Türk M, Gratzki N, Rompel O, Jungbluth H, Schröder R, Trollmann R. Compound heterozygous RYR1 mutations in a preterm with arthrogryposis multiplex congenita and prenatal CNS bleeding. Neuromuscul Disord 2017; 28:54-58. [PMID: 29169929 DOI: 10.1016/j.nmd.2017.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 08/28/2017] [Accepted: 09/18/2017] [Indexed: 01/23/2023]
Abstract
RYR1 mutations, the most common cause of non-dystrophic neuromuscular disorders, are associated with the malignant hyperthermia susceptibility (MHS) trait as well as congenital myopathies with widely variable clinical and histopathological manifestations. Recently, bleeding anomalies have been reported in association with certain RYR1 mutations. Here we report a preterm infant born at 32 weeks gestation with arthrogryposis multiplex congenita due to compound heterozygous, previously MHS-associated RYR1 mutations, with additional signs of prenatal hemorrhage. The patient presented at birth with multiple joint contractures, scoliosis, severe thoracic rigidity and respiratory failure. He continued to depend on mechanical ventilation and tube feeding. Muscle histopathology showed a marked myopathic pattern with eccentric cores. Interestingly, the patient had additional unusual prenatal intraventricular hemorrhage, resulting in post-hemorrhagic hydrocephalus as well as epidural hemorrhage affecting the spinal cord. This report adds to the phenotypic variability associated with RYR1 mutations, and highlights possible bleeding complications in affected individuals.
Collapse
Affiliation(s)
- Florian Brackmann
- Department of Pediatrics, Neuropediatrics, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Federal Republic of Germany.
| | - Matthias Türk
- Department of Neurology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Federal Republic of Germany
| | - Nils Gratzki
- Department of Pediatrics, Neonatology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Federal Republic of Germany
| | - Oliver Rompel
- Department of Radiology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Federal Republic of Germany
| | - Heinz Jungbluth
- Department of Pediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, St Thomas' Hospital, London, UK; Randall Division of Cell and Molecular, Biophysics Muscle Signalling Section, King's College, London, UK; Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College, London, UK
| | - Rolf Schröder
- Department of Neuropathology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Federal Republic of Germany
| | - Regina Trollmann
- Department of Pediatrics, Neuropediatrics, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Federal Republic of Germany
| |
Collapse
|
8
|
Gregorio-Hernández R, González-Valcarcel M, Escobar-Izquierdo AB, López-Lozano Y, Cabada-Del Río A. [Neonatal epidural haematoma. Presentation of 3 cases and a literature review]. An Pediatr (Barc) 2017; 88:50-51. [PMID: 28256345 DOI: 10.1016/j.anpedi.2017.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/13/2017] [Accepted: 01/17/2017] [Indexed: 11/19/2022] Open
|
9
|
Goymen M, Topcuoglu T, Aktan AM, Isman O. Cephalometric comparison of cesarean and normal births. Eur J Dent 2016; 10:199-202. [PMID: 27095896 PMCID: PMC4813435 DOI: 10.4103/1305-7456.178311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective: The aim of this study was to compare cephalometric variables of subjects with normal and cesarean births. Materials and Methods: Ninety age- and gender-matched patients, who were treated in Gaziantep University, Faculty of Dentistry Orthodontics Department were equally divided into normal and cesarean groups according to the birth methods reported by their mothers. To eliminate the negative effects of being different in terms of age and gender among parameters, control, and patient groups were matched in the present study. Pretreatment cephalometrics radiographs were used. Six measurements representing sagittal and vertical relationships were evaluated from pretreatment cephalograms using Dolphin Imaging Orthodontics Software was used in this issue by an orthodontist. Kolmogorov–Smirnov test, Student's t-test, and Mann–Whitney U-test were used for statistical comparisons. Results: A point-nasion-B point angle (ANB) and Wits values were higher in the normal group, while sella-nasion-A point angle, sella-nasion-B point angle, Frankfort horizontal-mandibular plane angle, and gonion-gnathion-SN plane angle values were higher in the cesarean group. However, the groups showed no significant differences (P > 0.05). ANB angle and Wits values showed high correlation. Conclusions: Within the study limitations, the results suggest that the birth method may not have a considerable effect on the development of the craniofacial skeletal system.
Collapse
Affiliation(s)
- Merve Goymen
- Department of Orthodontics, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkiye
| | - Tolga Topcuoglu
- Department of Orthodontics, Faculty of Dentistry, Zirve University, Gaziantep, Turkiye
| | - Ali Murat Aktan
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkiye
| | - Ozlem Isman
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkiye
| |
Collapse
|
10
|
Han BH, Song MJ, Lee KS, Kim YH, Ko SY, Jung G, Park SB, Lee SK. Superficial Echogenic Lesions Detected on Neonatal Cranial Sonography: Possible Indicators of Severe Birth Injury. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:477-484. [PMID: 26839370 DOI: 10.7863/ultra.15.04012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/17/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the characteristics and importance of superficial echogenic lesions around cranial sutures on neonatal cranial sonography. METHODS We retrospectively reviewed the clinical records and neuroimaging studies of 40 neonates who had superficial echogenic lesions around sutures on neonatal cranial sonography. Magnetic resonance imaging (n = 18) and computed tomography (n = 2) were performed within 2 weeks after sonography. We correlated sonographic findings with computed tomographic and magnetic resonance imaging findings and analyzed them. We also evaluated the associated lesions, neurologic signs, and follow-up changes. RESULTS Sonographically, the superficial echogenic lesions involved both sulci and perisulcal parenchyma in 39 neonates and were located in the frontal and parietal areas around the sagittal suture in 38 neonates. Magnetic resonance imaging revealed a pattern of hypoxic ischemic encephalopathy in 9 neonates, birth trauma in 3 neonates, a mixed pattern of hypoxic ischemic encephalopathy and trauma in 3 neonates, nonspecific single infarctions in 2 neonates, and lack of a defined lesion in 1 neonate. The associated lesions were subdural hemorrhage (n = 12), epidural hematoma (n = 4), germinal matrix hemorrhage (n = 3), intraventricular hemorrhage (n = 2), and periventricular leukomalacia (n = 1). All epidural hematomas were associated with scalp hematoma, and 2 patients had skull fractures. One neonate with epidural hematoma associated with a hypoxic ischemic encephalopathy pattern showed mild spasticity in both ankles until 16 months. CONCLUSIONS Superficial echogenic lesions detected around cranial sutures on neonatal sonography may be an indicator of more serious intracranial lesions such as more extensive hypoxic ischemic encephalopathy and intracranial hematomas, including epidural hematoma.
Collapse
Affiliation(s)
- Byoung Hee Han
- Departments of Radiology (B.H.H., M.J.S., K.S.L., Y.-H.K.) and Pediatrics (S.Y.K., G.J.), Dankook University College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea; Department of Radiology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea (S.B.P.); and Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Sinchon-dong, Seoul, Korea (S.-K.L.)
| | - Mi Jin Song
- Departments of Radiology (B.H.H., M.J.S., K.S.L., Y.-H.K.) and Pediatrics (S.Y.K., G.J.), Dankook University College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea; Department of Radiology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea (S.B.P.); and Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Sinchon-dong, Seoul, Korea (S.-K.L.).
| | - Kyung Sang Lee
- Departments of Radiology (B.H.H., M.J.S., K.S.L., Y.-H.K.) and Pediatrics (S.Y.K., G.J.), Dankook University College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea; Department of Radiology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea (S.B.P.); and Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Sinchon-dong, Seoul, Korea (S.-K.L.)
| | - Young-Hwa Kim
- Departments of Radiology (B.H.H., M.J.S., K.S.L., Y.-H.K.) and Pediatrics (S.Y.K., G.J.), Dankook University College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea; Department of Radiology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea (S.B.P.); and Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Sinchon-dong, Seoul, Korea (S.-K.L.)
| | - Sun Young Ko
- Departments of Radiology (B.H.H., M.J.S., K.S.L., Y.-H.K.) and Pediatrics (S.Y.K., G.J.), Dankook University College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea; Department of Radiology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea (S.B.P.); and Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Sinchon-dong, Seoul, Korea (S.-K.L.)
| | - Goun Jung
- Departments of Radiology (B.H.H., M.J.S., K.S.L., Y.-H.K.) and Pediatrics (S.Y.K., G.J.), Dankook University College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea; Department of Radiology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea (S.B.P.); and Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Sinchon-dong, Seoul, Korea (S.-K.L.)
| | - Sung Bin Park
- Departments of Radiology (B.H.H., M.J.S., K.S.L., Y.-H.K.) and Pediatrics (S.Y.K., G.J.), Dankook University College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea; Department of Radiology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea (S.B.P.); and Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Sinchon-dong, Seoul, Korea (S.-K.L.)
| | - Seung-Koo Lee
- Departments of Radiology (B.H.H., M.J.S., K.S.L., Y.-H.K.) and Pediatrics (S.Y.K., G.J.), Dankook University College of Medicine, Cheil General Hospital and Women's Healthcare Center, Seoul, Korea; Department of Radiology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea (S.B.P.); and Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Sinchon-dong, Seoul, Korea (S.-K.L.)
| |
Collapse
|
11
|
Josephsen JB, Kemp J, Elbabaa SK, Al-Hosni M. Life-threatening neonatal epidural hematoma caused by precipitous vaginal delivery. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:50-2. [PMID: 25633886 PMCID: PMC4315626 DOI: 10.12659/ajcr.892506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/13/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Neonatal in-hospital falls occur relatively frequently, although they are likely underreported. Significant intracranial head trauma from a fall or birth injury is not common in the immediate newborn period. Furthermore, intracranial bleeding requiring surgical intervention is exceedingly rare. We present an unusual case of an in-hospital fall in the delivery room requiring neurosurgical intervention. CASE REPORT A term infant, appropriate for gestational age, delivered precipitously from a maternal standing position. The vertex neonate struck the linoleum floor after an approximate 80-cm fall, landing headfirst. The physical and neurological exams were initially normal, and skull films did not demonstrate an obvious fracture. The baby was closely observed, undergoing continuous cardiorespiratory monitoring. After the patient had an episode of apnea, a scalp hematoma was noted. A computed tomography (CT) scan revealed a left parietal fracture with an acute epidural hematoma, which required emergent craniotomy. The infant had an unremarkable post-operative course and had a normal neurodevelopmental assessment at 15 months of age. CONCLUSIONS Close, continuous observation is recommended for infants following an in-hospital fall or after significant birth trauma. A high degree of suspicion for intracranial hemorrhage must be maintained. Fall prevention strategies should focus on careful baby handling by the convalescing mother.
Collapse
Affiliation(s)
- Justin B. Josephsen
- Department of Pediatrics, Division of Neonatology, Saint Louis University, Saint Louis, MO, U.S.A
| | - Joanna Kemp
- Department of Neurological Surgery, Division of Pediatric Neurosurgery, Saint Louis University, Saint Louis, MO, U.S.A
| | - Samer K. Elbabaa
- Department of Neurological Surgery, Division of Pediatric Neurosurgery, Saint Louis University, Saint Louis, MO, U.S.A
| | - Mohamad Al-Hosni
- Department of Pediatrics, Division of Neonatology, Saint Louis University, Saint Louis, MO, U.S.A
| |
Collapse
|
12
|
Kim HM, Kwon SH, Park SH, Kim YS, Oh KW. Intracranial hemorrhage in infants with cephalohematoma. Pediatr Int 2014; 56:378-81. [PMID: 24274929 DOI: 10.1111/ped.12255] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 10/10/2013] [Accepted: 11/05/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Intracranial hemorrhage (ICH) is a rare birth injury in term infants. Newborn infants with cephalohematoma (CH) associated with ICH, however, have frequently been found incidentally at Kyungpook National University Hospital; many of them had no neurological symptoms. The aim of this study was to evaluate the clinical manifestations of ICH in newborn infants with CH. METHODS Newborn infants with CH in the neonatal intensive care unit were retrospectively evaluated. During period I (5 years), neuroimaging (brain computed tomography and magnetic resonance imaging) was performed when intracranial abnormalities were suspected. During period II (36 months) neuroimaging was performed when CH > 5 cm in diameter was present. RESULTS During period I, seven out of 19 infants who underwent neuroimaging had ICH (36.8%) including two epidural hemorrhages (EDH). During period II, 18 out of 27 infants who underwent neuroimaging had ICH (66.7%), including two EDH. There was no significant difference in the clinical manifestations between infants with and without ICH. In 10 cases of CH accompanied with a linear skull fracture, nine had ICH, including all cases of ICH that needed intervention. CONCLUSIONS The association of ICH appears to be common in newborn infants with CH; particularly in infants with CH accompanied with a skull fracture, the rate of ICH was very high, and all cases of EDH requiring intervention were associated with skull fracture. Therefore, evaluation of accompanying skull fracture should be required in infants with CH, and, in cases of skull fracture, neuroimaging should be considered.
Collapse
Affiliation(s)
- Heng Mi Kim
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
| | | | | | | | | |
Collapse
|
13
|
Abstract
Epidural hematoma (EDH) in newborn infants is rare compared with other types of intracranial hemorrhages. Furthermore, posterior fossa EDH is extremely rare. We present a case of posterior fossa EDH in an infant with Menkes disease with accessory bones in the occiput. A male infant with a condition diagnosed with Menkes disease by prenatal testing was born at 39 weeks via vacuum extraction. The patient presented with a mild tremor at 2 days after delivery. A brain computed tomography (CT) scan showed an acute EDH in the posterior fossa, extending into the occipitoparietal area. Three-dimensional CT and bone window CT scan revealed several accessory bones, diastasis of 1 accessory suture, a communicated fracture, and a linear fracture in the occipital bone. Furthermore, a bone fragment from a communicated fracture displaced toward the inside. The patient was treated conservatively for EDH because of his good general condition. The hematoma gradually resolved, and his tremor did not recur. We suggest the following mechanism of posterior fossa EDH development in our patient: (1) external force was applied to the occiput inside the birth canal during delivery, resulting in diastasis; (2) a communicated fracture occurred, and a bone fragment displaced toward the inside (linear fracture was caused indirectly by the force); (3) a transverse sinus was injured by the fragment; and (4) EDH developed in both the posterior fossa and supratentorial region. Copper deficiency can also cause fragility of connective tissues, vessels, and bones.
Collapse
|
14
|
Abstract
Despite a greatly decreasing incidence of birth injuries over the past several decades with birth trauma currently accounting for less than 2% of neonatal deaths, birth trauma continues to be a significant cause of morbidity and mortality. Birth trauma is usually recognized by obstetricians and pediatricians, particularly when associated with a difficult delivery; therefore many birth injuries are diagnosed and documented in the neonatal period. Other delivery-related trauma may remain clinically silent without premortem identification. The challenge for the pathologist at autopsy is to correlate a history of birth trauma with injuries seen at autopsy, and to interpret injuries existing at death to accurately include or exclude birth trauma as a potential cause. Recognition of the spectrum of birth trauma is important when considering other accidental and nonaccidental mechanisms of injury, particularly in cases of unwitnessed perinatal death following delivery of a concealed pregnancy or in cases of alleged nonaccidental trauma. Discussed here is a general review of birth trauma that may be seen in a forensic setting to aid in interpretation of injuries that can be encountered.
Collapse
Affiliation(s)
- Kelly C. Lear-Kaul
- Forensic Pathologist at the Arapahoe County (Colorado) Coroner's Office and University of Colorado Anschutz Medical Campus
| |
Collapse
|
15
|
Kroon E, Bok LA, Halbertsma F. Spontaneous perinatal epidural haemorrhage in a newborn. BMJ Case Rep 2012; 2012:bcr.09.2011.4735. [PMID: 22665463 DOI: 10.1136/bcr.09.2011.4735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A full-term neonate, born by caesarean section, presents with focal seizures. EEG and cranial ultrasound are normal. MRI of the cerebrum shows an epidural haematoma. Perinatal intracranial haemorrhage in the full-term newborn is an important cause of morbidity and mortality. Most perinatal intracranial haemorrhages are located either subdural or intracerebral, rarely epidural. Epidural haemorrhage is usually a complication of assisted delivery, however it may also occur without forcipal or vacuum extraction, as demonstrated in this case. An epidural haemorrhage should be suspected on clinical findings, even in the absence of an assisted delivery. As cranial ultrasound sonography often misses epidural haemorrhage due to parietal location of the haemorrhage, the diagnosis needs either cerebral CT or MRI.
Collapse
Affiliation(s)
- Elke Kroon
- Pediatrics Department, Maxima Medisch Centrum Veldhoven, Veldhoven, Netherlands
| | | | | |
Collapse
|
16
|
Scheibl A, Calderón EM, Borau MJG, Prieto RM, González PF, Galiana GG. Epidural hematoma. J Pediatr Surg 2012; 47:e19-21. [PMID: 22325415 DOI: 10.1016/j.jpedsurg.2011.10.078] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 10/23/2011] [Accepted: 10/28/2011] [Indexed: 10/14/2022]
Abstract
Epidural hematomas are rare birth injuries, and spontaneous presentation is exceptional. We present 2 cases of newborns with spontaneous epidural hematomas after delivery. In both cases, cerebral hemorrhage was associated with skull fracture and cephalohematoma. One newborn presented with neurologic symptoms in the form of convulsions, whereas the other was asymptomatic. Confirmation of the diagnosis was made by cranial computed tomography. Both cases were treated surgically by craniotomy. Follow-up showed normal neurologic development.
Collapse
Affiliation(s)
- Alexandra Scheibl
- Division of Neonatology, Department of Pediatrics, Hospital Sant Pau I Santa Creu, Barcelona, Spain.
| | | | | | | | | | | |
Collapse
|
17
|
Paiva WS, Andrade AFD, Mathias Júnior L, Guirado VMDP, Amorim RL, Magrini NN, Teixeira MJ. Management of supratentorial epidural hematoma in children: report on 49 patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 68:888-92. [PMID: 21243247 DOI: 10.1590/s0004-282x2010000600011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 06/07/2010] [Indexed: 11/22/2022]
Abstract
Traumatic head injury is a common cause of mortality and acquired neurological impairment in children. However, pediatric epidural hematomas (EDHs) are not common and few series have studied the evolution of these patients. In this study, we present the results from a sample of patients with EDH with long-term follow-up. METHOD: Between January 2006 and December 2008, 49 patients with traumatic EDH were treated at our unit. Clinical course, radiological findings and outcomes were evaluated. Neurological status was assessed using the Glasgow Coma Scale (GCS). The patients' ages ranged from one day to 16 years. The mean follow-up was six months. RESULTS: On admission, most of the patients presented mild trauma and 57% had a GCS of 13-15. The most common symptom was irritability. The most frequent mechanisms of injury were: falling from a height in 29 cases and motor vehicle accidents in 16 cases. Three of these patients presented GCS 3, but only one died. We found a late neurological deficit in nine patients. CONCLUSION: These lesions may occur following mild head trauma and in alert children with nonfocal neurological examinations. However, in children presenting irritability with subgaleal hematomas and a history of loss of consciousness, skull computed tomography must be performed.
Collapse
|
18
|
Noguchi M, Inamasu J, Kawai F, Kato E, Kuramae T, Oyanagi T, Takahashi T, Ihara M. Ultrasound-guided needle aspiration of epidural hematoma in a neonate after vacuum-assisted delivery. Childs Nerv Syst 2010; 26:713-6. [PMID: 20076989 DOI: 10.1007/s00381-009-1072-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 12/14/2009] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Epidural hematoma (EDH) is a rare complication of vacuum-assisted delivery in neonates. Although the standard treatment of EDH is surgical evacuation via craniotomy, it is an invasive procedure in neonates, and less invasive methods may be favored for hematoma evacuation. CASE REPORT We report a case of 5-day-old infant with a massive EDH, cephalohematoma, and a depressed fracture, which were secondary to a vacuum-assisted delivery and cured by ultrasound-guided needle aspiration and drainage. Neonatal EDH may be different from adult counterpart in that the former is more liquefied and is amenable to needle aspiration than the latter. Although needle aspiration is a blind procedure, addition of transcranial ultrasound not only ensures safety by visualizing the tip of the needle but also makes real-time evaluation of the residual hematoma volume possible.
Collapse
MESH Headings
- Adult
- Drainage/methods
- Female
- Hematoma, Epidural, Cranial/etiology
- Hematoma, Epidural, Cranial/pathology
- Hematoma, Epidural, Cranial/surgery
- Humans
- Infant, Newborn
- Magnetic Resonance Imaging
- Pregnancy
- Tomography, X-Ray Computed
- Ultrasonography, Interventional/methods
- Vacuum Extraction, Obstetrical/adverse effects
Collapse
Affiliation(s)
- Motomi Noguchi
- Department of Pediatrics, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Smets KJ, Vanhauwaert D. Treatment of cranial epidural hematoma in a neonate by needle aspiration of a communicating cephalhematoma. Eur J Pediatr 2010; 169:617-9. [PMID: 19834739 DOI: 10.1007/s00431-009-1071-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Accepted: 09/07/2009] [Indexed: 11/25/2022]
Abstract
A newborn presented on day 15 of life with an epidural hematoma, extending through a diastatic sutura squamosa in an external cephalhematoma. There was no skull fracture. The cephalhematoma was punctured twice with 24-h interval, reducing both the cephalhematoma and the epidural component. In the absence of neurological signs or symptoms, aspirating a cephalhematoma to evacuate the communicating epidural hematoma in a newborn infant may avoid more invasive surgical intervention.
Collapse
Affiliation(s)
- Koenraad Jan Smets
- Neonatal Intensive Care Unit, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium.
| | | |
Collapse
|
20
|
Yu DK, Heo DH, Cho SM, Cho YJ. Rapidly calcified epidural hematoma in a neonate. J Korean Neurosurg Soc 2008; 44:98-100. [PMID: 19096702 DOI: 10.3340/jkns.2008.44.2.98] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 07/24/2008] [Indexed: 11/27/2022] Open
Abstract
We report a very rare case of a rapidly calcified chronic epidural hematoma (EDH) in a neonate. A 26-day-old female infant was referred to us from a regional hospital because of drowsy mentality and a seizure attack. She was delivered through caesarian section because normal spontaneous vaginal delivery was prolonged and failed. At birth, mild scalp swelling was found on the right frontal area. Scalp swelling was spontaneously resolved and she was discharged without any problems. On the 25th day after her birth, the baby presented with drowsiness and hypotonia following a generalized tonic-clonic seizure. Magnetic resonance imaging (MRI) and a computed tomography (CT) scan revealed a chronic EDH that had a thick layer of calcification. A small burr-hole trephination was performed and a single silastic drainage catheter was inserted. After the operation, a total of 12 ml of liquefied hematoma was drained, and the patient's mentality improved from drowsiness to alertness. The patient was asymptomatic when discharged.
Collapse
Affiliation(s)
- Dong Kun Yu
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, Korea
| | | | | | | |
Collapse
|
21
|
Oh KW, Kim HM. Epidural hematoma treated by aspiration of accompanying cephalhematoma in a newborn infant. KOREAN JOURNAL OF PEDIATRICS 2007. [DOI: 10.3345/kjp.2007.50.11.1125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ki Won Oh
- Department of Pediatrics, College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Heng Mi Kim
- Department of Pediatrics, College of Medicine, Kyungpook National University, Daegu, Korea
| |
Collapse
|
22
|
Abstract
In this article "perinatal trauma" is restricted to injuries that are sustained by the infant during the labor and delivery primarily as a result of mechanical factors, with the understanding that even under optimal circumstances, the process of birth is traumatic. Mechanical insults to the perinatal brain may result in primarily a hypoxic or ischemic injury to the cerebral tissues; those conditions are not discussed in this article. Although there are multiple types of perinatal trauma, this article is restricted mainly to those types that impact upon the subsequent development of cerebral palsy, although when applicable, other adverse developmental outcomes are mentioned.
Collapse
Affiliation(s)
- Michael J Noetzel
- Department of Neurology, St. Louis Children's Hospital, MO 63110, USA.
| |
Collapse
|