Spot Diagnosis

Right parietal Swelling

Karam Chand, Stuti Misra
Department of Neurosurgery, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi

Address for Correspondence: Dr Karam Chand Stuti Misra, D-2, B-11, Moti Bagh, New Delhi.
Question :
A 4 days old infant presented with right parietal scalp swelling since birth. The child was delivered vaginally by application of forceps to a primigravida mother. Apart from swelling there were no other symptoms. The head circumference was 35cm, anterior and posterior fontellae were flat and little tense. The child had right parietal scalp swelling 3cm in diameter which was soft little tender and transillumination was negative. The child was active , vitals were stable, was accepting feeds normally and had no neurological deficit. CT head was done that shows the following:

What is the diagnosis?

Discussion :
CT Head was done which showed right parietal extradural haematoma. No calvarial fracture could be demonstrated on bone windows. The child was managed conservatively and showed gradual reduction of swelling. Three months later the child had normal head with all swelling gone and had normal milestones.
Extradural haematomas are uncommon in infants and many of them can be treated conservatively. Infants tolerate extradural haematomas better than adult because of open fontenallae and skull sutures. Any infant with scalp swelling which persist must have CT scan to rule out intracranial haematoma. The indication for removal of extradural haematoma is clinicoradiological. Extradural haematomas in children are rarely associated with other brain injuries. Overlying calvarial fractures also is not that common in children as compared to adults.

E-published September 2009 Vol 6 Issue 9 Art # 51

Correct Answers : yes  21%

Last Shown : Aug 2009
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