Traumatic Intracranial Hematomas

Pediatric Traumatic Intracranial Hematoma refers to bleeding inside the skull due to head trauma in infants, children, or adolescents. These hemorrhages can occur in various spaces around the brain and may lead to increased intracranial pressure (ICP), brain herniation, seizures, or permanent neurological damage if not diagnosed and treated promptly. In Bangladesh, traumatic brain injuries (TBI) are among the top causes of emergency hospital visits for children. Despite this, timely detection and neurosurgical treatment of intracranial bleeding is often delayed due to limited awareness, transportation delays, and lack of specialized pediatric neurocenters. Dr. Md. Nafaur Rahman, with his expert team, offers comprehensive evaluation, emergency surgery, and long-term care for affected children at NINS and Bangladesh Paediatric Neurocare Centre. 🧬 Types of Intracranial Hematomas in Children Depending on the location and mechanism of injury, the following types of hematomas may occur in pediatric patients: 🔸 1. Epidural (Extradural) Hematoma Bleeding between the skull and the dura mater Often associated with skull fracture Classically presents with a lucid interval followed by rapid deterioration 🔸 2. Subdural Hematoma Bleeding between the dura and the arachnoid layer More common in infants and toddlers due to fragile bridging veins May present with lethargy, vomiting, seizures, and bulging fontanelle 🔸 3. Intracerebral (Intraparenchymal) Hematoma Bleeding inside the brain tissue Usually results from high-velocity trauma Carries high risk of brain swelling and functional impairment 🔸 4. Subarachnoid Hemorrhage Blood in the subarachnoid space, often diffuse Can result in headache, altered consciousness, or hydrocephalus 🔸 5. Intraventricular Hemorrhage (IVH) Bleeding into the brain’s ventricular system May block CSF flow and cause post-traumatic hydrocephalus Each type requires a unique approach in diagnosis, surgical planning, and postoperative care. ⚠️ Common Causes in Bangladesh Pediatric intracranial hematomas typically occur after: 🚗 Road traffic accidents (RTAs) – motorcycle or rickshaw accidents 🧱 Falls from rooftops or trees – especially in rural or urban slum areas 🪑 Domestic accidents – falls from beds, stairs, or furniture 🏫 School-related injuries – sports trauma, falls from height 🔫 Penetrating or blunt trauma – from objects, tools, or abuse 🚨 Birth trauma (rare, but possible in neonates) In many rural and semi-urban areas of Bangladesh, children are brought late to hospitals, often missing the golden hour for effective intervention. 🏥 Signs & Symptoms That Warrant Emergency Care Parents, caregivers, and first responders should seek immediate medical attention if the child shows: Loss of consciousness after head injury Repeated vomiting or projectile vomiting Seizures or abnormal posturing Severe headache or irritability Dilated or unequal pupils Weakness in limbs or unresponsiveness Bulging of fontanelle in infants Clear fluid or blood from ears/nose "In a developing brain, a few minutes of pressure can result in a lifetime of disability. Early diagnosis saves both function and future." — Dr. Md. Nafaur Rahman 🧪 Diagnostic Protocol at NINS and BP Neurocare Dr. Nafaur’s team follows a fast-tracked diagnostic process for suspected cases of intracranial bleeding: ✅ Imaging Tools: Non-contrast CT Brain – First-line for acute hemorrhage and mass effect CT Angiography – If vascular injury is suspected MRI Brain (T1/T2/FLAIR/Gradient Echo) – For follow-up and subtle bleeds Neurosonography – For infants with open fontanelle ICP Monitoring – For severe TBI and swelling In emergency situations, the diagnostic-to-intervention time is minimized for better outcomes. 🛠️ Neurosurgical Management of Intracranial Hematomas Timely surgery is often the key to survival and neurological recovery. Surgical intervention is recommended when there is: Large hematoma causing mass effect Significant midline shift on imaging Decreased Glasgow Coma Scale (GCS) Signs of impending herniation Failed conservative management Surgical Procedures Include: Craniotomy with hematoma evacuation Decompressive craniectomy for severe brain swelling Drain placement or EVD insertion Repair of skull fracture and dural tear VP Shunt placement for post-traumatic hydrocephalus Dr. Nafaur Rahman performs these surgeries using microsurgical techniques, neuro-navigation, and intraoperative monitoring, ensuring child safety and precision. 🔁 Postoperative Care & Long-Term Follow-Up Following surgery, the child is monitored in the pediatric neuro-ICU with: 🩺 Vital sign and intracranial pressure monitoring 💉 Anticonvulsants for seizure control 🧪 Infection control protocols 💊 Rehabilitation planning Long-Term Complications to Monitor: Seizures (post-traumatic epilepsy) Motor weakness or spasticity Learning or memory issues Behavioral changes or sleep disorders Speech/language difficulties Hydrocephalus or shunt dependency Children are followed up regularly at Bangladesh Paediatric Neurocare Centre with access to neurorehabilitation, physiotherapy, and psychological support. 🌍 Bangladesh Perspective: Barriers and Progress Major Challenges: ❗ Late presentation to hospitals from rural areas 🚑 Lack of ambulance support or trauma systems 😷 Insufficient neurosurgical expertise outside Dhaka 📉 Public unawareness of head trauma red flags 💰 Financial limitations in accessing CT/MRI scans Dr. Nafaur Rahman’s Solutions: Runs outreach awareness programs on pediatric head injury Partners with NGOs for support to underprivileged families Advocates for safe environments in homes, schools, and roads Coordinates with local physicians for early referral systems Provides affordable neurosurgical care at NINS and BP Neurocare 👨‍⚕️ Why Choose Dr. Md. Nafaur Rahman? 🧠 Renowned expert in emergency pediatric brain trauma surgery 🏥 Works at NINS, Bangladesh’s premier government neuroscience hospital 👶 Combines clinical experience with compassion for children and their families 🧰 Equipped with advanced surgical tools and neuro-monitoring systems 🤝 Offers full-spectrum care from emergency to rehabilitation 📞 Contact for Pediatric Head Trauma Emergency or Consultation Dr. Md. Nafaur Rahman Assistant Professor, Pediatric Neurosurgery, NINS Chief Consultant, Bangladesh Paediatric Neurocare Centre 📱 For Serial/Appointment: 📞 01912988182 | 📞 01607033535 🌐 Website: www.neurosurgeonnafaur.com