Epidural Hematomas in Children

Dr. Charles L. Rosen, Neurosurgeon of Morgantown, WV, explains epidural hematomas in children.

I do like to talk about one instance, or actually two instances, the same problem that I’ve seen twice in my career and that’s something that you can see in kids in particular called a Talk and Die Hematoma. What happens in the Talk and Die Hematoma, you get a skull fracture and when the skull fracture occurs, a blood vessel gets torn, but the skull fracture is in a very thin part of the skull and an area where sometimes the child does recover quick enough that they don’t seek medical care. The two instances that I’ve seen this was a child who was doing what we always caution children not to do, running alongside the pool and slipping and falling. The other would be a child who got hit by a baseball bat, when the person who is swinging the bat hit the ball and then threw the bat as they ran to first base, and the bat hit the pitcher in the side of the head.

In both these instances by striking the side of the head, an artery that runs underneath the skull–underneath the thick muscle skull and then inside the skull–it gets cut by the sharp edge of the broken bone. I think because of the thick muscle and the thin bone, the fact that the force doesn’t have to be so great since the bones thin, in both these instances, the child got up, was in some distress from the pain of what had just occurred, but in a short period of time was consolable by family and then even returned back saying, “okay, I’m fine,” and went back to doing what they were doing. In both these instances, approximately an hour later, hour and a half, a child started complaining of severe headaches suddenly and became tired, and one of them started having all sorts of nausea and vomiting. You know, do not pass go, do not collect $200, go straight to the emergency room.

Because what’s happened is that small blood vessel that got lacerated is bleeding between the skull and the covering of the brain, there’s something called the Dura, and they develop what’s called an Epidural Hematoma–a collection of blood outside the covering of the brain. And initially it’s just a little slither and it doesn’t do very much, but as it gets bigger and pushes on the brain more, that ultimately causes the brain to stop functioning and this is life-threatening. If the Hematoma is not evacuated and the bleeding stopped, the child will die. So the good news is when these children are brought in under these emergent circumstances, it’s a relatively straightforward operation to open the scalp, open the skull, identify the bleeding artery, stop the bleeding, and actually have the child do just beautifully. So I’ve been fortunate enough to be able to care for two children under those circumstances–not fortunate they got hurt, but fortunate that I was able to help them and have them return to absolutely normal lives with no sequelae of the scary, yet a fixable problem.

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