Case: 6-year-old Girl Hits Her Head

by Roy Strowd, MD

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    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.

    About the Lecture

    The lecture Case: 6-year-old Girl Hits Her Head by Roy Strowd, MD is from the course Head Trauma.

    Included Quiz Questions

    1. Epidural hematoma
    2. Intraparenchymal hemorrhage
    3. Concussion
    4. Subdural hematoma
    5. Subarachnoid hemorrhage
    1. Intraparenchymal hemorrhage
    2. Subdural hematoma
    3. Lacunar infarct
    4. Epidural hematoma
    5. Subarachnoid hemorrhage

    Author of lecture Case: 6-year-old Girl Hits Her Head

     Roy Strowd, MD

    Roy Strowd, MD

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