Pediatric acute epidural hematoma caused by contrecoup injury: illustrative case

BACKGROUND: Acute epidural hematomas (AEDHs) are formed by injury of the middle meningeal artery or venous sinus with a linear fracture just above these blood vessels. The incidence of AEDH without fracture is low, and the formation of an acute epidural hematoma due to contrecoup injury is even rarer. Here, the authors report a case of pediatric AEDH due to contrecoup injury. OBSERVATIONS: A 6-year-old boy was injured in a traffic accident and was ejected from of the car. At admission, he was clearly conscious without obvious neurological deficits. Computed tomography (CT) revealed a small fracture in the right occipital lobe and a thin epidural hematoma in the contralateral left frontal lobe. A CT scan 3 hours later showed an expanded AEDH. Furthermore, the patient presented with progressive disturbance of consciousness. An emergency craniotomy was performed, but no obvious bleeding point or fracture was observed. LESSONS: The source of bleeding in AEDH due to contrecoup injury in the frontal region is thought to be due to microvessel injury in the dura. Anatomical fragility and the amount of energy transferred causing the injury are associated with the AEDH formation due to contrecoup injury; thus, strict management in high-energy trauma is required.