Hypodensity of extradural hematomas in children: an ominous sign

Clinical article

Khursheed Nayil M.S., M.Ch. 1 , Altaf Ramzan M.S., M.Ch. 1 , Sajad Arif M.S., M.Ch. 1 , Abrar Wani M.S., M.Ch. 1 , Zahoor Sheikh M.S., M.Ch. 1 , Tariq Wani M.Sc. 2 , Masood Laharwal M.S., M.Ch. 1 and Anil Dhar M.S., M.Ch. 1
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  • 1 Departments of Neurosurgery and
  • 2 Biostatistics, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
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Object

The aim of this study was to analyze the correlation of hypodensity in extradural hematomas on CT with the clinical profile in pediatric patients. This is the only study available in this age group.

Methods

This was a prospective study conducted over a period of 3 years in which all children 18 years old or younger with a diagnosis of cranial extradural hematoma were included. The patients were allocated to 2 groups: those with mixed-density clots (17 cases) and those with classically hyperdense clots (52 cases). A comparative analysis between the 2 groups was conducted.

Results

Patients with mixed-density clots presented earlier to the hospital, had poor Glasgow Coma Scale scores at admission, exhibited large clot volumes, had a high incidence of active bleeding at surgery, and had increased morbidity and mortality as compared with the patients with hyperdense extradural hematomas.

Conclusions

Early recognition and rapid evacuation of the mixed-density clot with restoration of hemostasis may result in a decline in morbidity and death in children with this entity.

Abbreviations used in this paper: GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale.

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Contributor Notes

Address correspondence to: Khursheed Nayil, M.S., M.Ch., Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India 190 011. email: nayilkhursh@gmail.com.
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