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Delayed extradural haemorrhage: A case for intracranial pressure monitoring in sedated children with traumatic brain injury within tertiary centres

Delayed extradural haemorrhage: A case for intracranial pressure monitoring in sedated children with traumatic brain injury within tertiary centres
Delayed extradural haemorrhage: A case for intracranial pressure monitoring in sedated children with traumatic brain injury within tertiary centres

A 15-year-old girl sustained a mild isolated traumatic brain injury following a pedestrian road traffic accident. She was ventilated for head computed tomography (CT) scan which revealed no intracranial abnormalities. Ventilation was not withdrawn until 15 h later when poor neurological recovery prompted urgent repeat CT, which demonstrated a delayed extradural haemorrhage (EDH). She underwent surgical evacuation, and intracranial pressure (ICP) monitoring was initiated postoperatively. She developed persistently raised ICP resistant to medical therapy, prompting further CT. This showed a recurrence of the delayed EDH requiring further surgical drainage. She made a good neurological recovery. There should be a low threshold for repeat CT to exclude delayed EDH when neurological status is poor despite normal CT soon after initial primary injury. ICP monitoring should be undertaken in children and adolescents who have normal initial CT, but in whom serial neurological assessment is not possible owing to sedation.

1757-790X
Hughes, Anna
e0973cf4-bb70-4273-b1b2-75867938e522
Lee, Conrad
bd635071-e8ca-4fdc-99c1-cc1f3cd46fb9
Kirkham, Fenella
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Durnford, Andrew J.
5b49b848-cf34-4024-9399-c342d71b09b6
Hughes, Anna
e0973cf4-bb70-4273-b1b2-75867938e522
Lee, Conrad
bd635071-e8ca-4fdc-99c1-cc1f3cd46fb9
Kirkham, Fenella
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Durnford, Andrew J.
5b49b848-cf34-4024-9399-c342d71b09b6

Hughes, Anna, Lee, Conrad, Kirkham, Fenella and Durnford, Andrew J. (2013) Delayed extradural haemorrhage: A case for intracranial pressure monitoring in sedated children with traumatic brain injury within tertiary centres. BMJ Case Reports, [007543]. (doi:10.1136/bcr-2012-007543).

Record type: Article

Abstract

A 15-year-old girl sustained a mild isolated traumatic brain injury following a pedestrian road traffic accident. She was ventilated for head computed tomography (CT) scan which revealed no intracranial abnormalities. Ventilation was not withdrawn until 15 h later when poor neurological recovery prompted urgent repeat CT, which demonstrated a delayed extradural haemorrhage (EDH). She underwent surgical evacuation, and intracranial pressure (ICP) monitoring was initiated postoperatively. She developed persistently raised ICP resistant to medical therapy, prompting further CT. This showed a recurrence of the delayed EDH requiring further surgical drainage. She made a good neurological recovery. There should be a low threshold for repeat CT to exclude delayed EDH when neurological status is poor despite normal CT soon after initial primary injury. ICP monitoring should be undertaken in children and adolescents who have normal initial CT, but in whom serial neurological assessment is not possible owing to sedation.

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Published date: 2013

Identifiers

Local EPrints ID: 424270
URI: http://eprints.soton.ac.uk/id/eprint/424270
ISSN: 1757-790X
PURE UUID: da2140be-a2e1-41f0-910a-2f712b0c645e
ORCID for Fenella Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

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Date deposited: 05 Oct 2018 11:35
Last modified: 16 Mar 2024 03:22

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Contributors

Author: Anna Hughes
Author: Conrad Lee
Author: Fenella Kirkham ORCID iD
Author: Andrew J. Durnford

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