C A S E O F T H E M O N T H
EPIDURAL HEMATOMA
A 5 year old girl was playing with her cousins when she accidentally slipped and fell off a ledge that was 4 feet high. She did not lose consciousness and started crying immediately. However, she vomited 3 times right after the fall, and was rushed to the nearest hospital.
At the ER, the child became drowsy and unresponsive. She kept her eyes closed and refused to respond even when her mother was calling her. She was able to move her left side when tested but was unable to move her right. Stat CT scan of the brain showed a large epidural hematoma on the left side.
An epidural hematoma is a blood clot that forms between the bone and the dura, the outer covering of the brain. It is caused by head injury in almost all cases. The type of treatment depends on the size of the blood clot and the condition of the patient. If the patient is awake and the clot is small, observation and conservative treatment can be done. However, if the patient is drowsy and the blood clot is large, emergency surgery may be needed to remove the blood clot that is compressing the brain. If the surgery is performed immediately, the results are usually very good, and full recovery is expected as long as there are no other injuries.
The patient was immediately brought to the operating room for emergency surgery for removal of the blood clot.
After the operation, the patient improved dramatically. She was awake and able to answer questions and follow commands. She complained that she was hungry and asked for food. Her weakness improved and soon she was able to move her arms and legs with equal strength. She went home much improved after a few days.
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