• D Kaech and S Burger.
• Service de Neurochirurgie, CHUV, Lausanne.
• Z Kinderchir. 1988 Jun 1; 43 (3): 195-9.

AbstractThe different modes of presentation of extradural haematomas in children are discussed, based on the clinical data of 13 patients (12 operated and one conservatively treated). In a 12-month-old infant, anaemia and bradycardia were the first signs of the haematoma, whereas stupor and apnoeic respiration pattern were seen in a 5-year-old boy. Both children had neither pupillary dilatation nor focal neurological signs. Four children were operated on a classical extradural haematoma. In 3 cases the skull fracture was missed in the peripheral referring hospital. A secondary deterioration of the level of consciousness after a free interval was discovered late in one patient, who had already a unilaterally fixed and dilated pupil and developed a decerebrate posture. In this child with a radiologically proven skull fracture on the side of the pupillary dilatation, who became comatose after a lucid interval, we performed emergency burr holes in casualty. Although CT-scan is the method of choice for the diagnosis of intracranial haematomas, it would be a dangerous loss of time to submit patients with the typical features of an extradural haematoma who present with signs of brainstem compression to this examination. 2 EDH developed under a depressed skull fracture. In a haemophiliac child, a radiologically not detected skull fracture was discovered during surgery. In two patients who were again deteriorating after 4 and 12 days a second CT scan showed a delayed extradural haematoma. Another patient was referred on the 7th day with a posterior fossa EDH. A small epidural bleeding resolved spontaneously under conservative treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

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