Abstract：
OBJECTIVE: To report a rare case of spontaneous bilateral epidural hematoma (EDH) in a 10-year-old Nigerian child with sickle cell disease (SCD) and review the literature regarding this unusual complication.
METHODS: We present a case of a pediatric patient with SCD who developed a spontaneous bilateral EDH and discuss the potential underlying mechanisms, management approaches, and outcomes. We also conducted a literature review of existing cases of spontaneous EDH in patients with SCD.
RESULTS: Our patient initially presented with a subgaleal hematoma and underlying bilateral EDH, but she was sent home without any neurosurgical consultation. Two years later, she returned with altered consciousness and left-sided weakness, revealing an increased size of the EDH with a noticeable mass effect. She underwent a successful emergency bilateral craniotomy, with noticeable improvement in her level of consciousness and left-sided weakness post-operatively. In our literature review, we found 40 reported cases of spontaneous EDH in SCD patients, with a male predominance (82.5%). The average age of patients was 15.282 years. The most common hematoma location was bifrontal (20%) and the most reported symptom was headache (47.5%). Most patients (97.5%) were already known cases of SCD. Among those treated, 77.5% survived.
CONCLUSIONS: Spontaneous bilateral EDH in SCD patients is an uncommon complication, with a variety of proposed pathophysiological mechanisms. Prompt recognition and appropriate management, either conservative or surgical, are crucial to improve outcomes. Our case and literature review underscore the importance of considering spontaneous EDH in SCD patients presenting with neurological symptoms, even in the absence of trauma. Further research is needed to elucidate the precise etiology, identify risk factors, and optimize management approaches for this rare complication in SCD patients.
METHODS: We present a case of a pediatric patient with SCD who developed a spontaneous bilateral EDH and discuss the potential underlying mechanisms, management approaches, and outcomes. We also conducted a literature review of existing cases of spontaneous EDH in patients with SCD.
RESULTS: Our patient initially presented with a subgaleal hematoma and underlying bilateral EDH, but she was sent home without any neurosurgical consultation. Two years later, she returned with altered consciousness and left-sided weakness, revealing an increased size of the EDH with a noticeable mass effect. She underwent a successful emergency bilateral craniotomy, with noticeable improvement in her level of consciousness and left-sided weakness post-operatively. In our literature review, we found 40 reported cases of spontaneous EDH in SCD patients, with a male predominance (82.5%). The average age of patients was 15.282 years. The most common hematoma location was bifrontal (20%) and the most reported symptom was headache (47.5%). Most patients (97.5%) were already known cases of SCD. Among those treated, 77.5% survived.
CONCLUSIONS: Spontaneous bilateral EDH in SCD patients is an uncommon complication, with a variety of proposed pathophysiological mechanisms. Prompt recognition and appropriate management, either conservative or surgical, are crucial to improve outcomes. Our case and literature review underscore the importance of considering spontaneous EDH in SCD patients presenting with neurological symptoms, even in the absence of trauma. Further research is needed to elucidate the precise etiology, identify risk factors, and optimize management approaches for this rare complication in SCD patients.
摘要：
目的：报道一例10岁尼日利亚镰状细胞病（SCD）患儿自发性双侧硬膜外血肿（EDH）的罕见病例，并回顾有关这种异常并发症的文献。
方法：我们介绍了一例SCD患儿发生自发性双侧EDH的病例，并讨论了潜在的潜在机制。管理方法，和结果。我们还对SCD患者中自发性EDH的现有病例进行了文献综述。
结果：我们的患者最初表现为盖下血肿和潜在的双侧EDH，但她没有经过任何神经外科会诊就被送回家了.两年后,她带着改变的意识和左侧的弱点回来，揭示EDH的尺寸增加，具有明显的质量效应。她成功地进行了紧急双侧开颅手术,术后她的意识水平和左侧无力明显改善。在我们的文献综述中，我们在SCD患者中发现了40例自发性EDH，以男性为主（82.5%）。患者平均年龄为15.282岁。最常见的血肿位置是双额（20％），最多报告的症状是头痛（47.5％）。大多数患者（97.5％）是已知的SCD病例。在接受治疗的人中，77.5%存活。
结论：SCD患者自发性双侧EDH是一种罕见的并发症，具有多种已提出的病理生理机制。及时识别和适当的管理，保守或手术，对改善结果至关重要。我们的病例和文献综述强调了在出现神经症状的SCD患者中考虑自发性EDH的重要性。即使没有外伤.需要进一步的研究来阐明确切的病因，识别风险因素，并优化SCD患者这种罕见并发症的管理方法。
方法：我们介绍了一例SCD患儿发生自发性双侧EDH的病例，并讨论了潜在的潜在机制。管理方法，和结果。我们还对SCD患者中自发性EDH的现有病例进行了文献综述。
结果：我们的患者最初表现为盖下血肿和潜在的双侧EDH，但她没有经过任何神经外科会诊就被送回家了.两年后,她带着改变的意识和左侧的弱点回来，揭示EDH的尺寸增加，具有明显的质量效应。她成功地进行了紧急双侧开颅手术,术后她的意识水平和左侧无力明显改善。在我们的文献综述中，我们在SCD患者中发现了40例自发性EDH，以男性为主（82.5%）。患者平均年龄为15.282岁。最常见的血肿位置是双额（20％），最多报告的症状是头痛（47.5％）。大多数患者（97.5％）是已知的SCD病例。在接受治疗的人中，77.5%存活。
结论：SCD患者自发性双侧EDH是一种罕见的并发症，具有多种已提出的病理生理机制。及时识别和适当的管理，保守或手术，对改善结果至关重要。我们的病例和文献综述强调了在出现神经症状的SCD患者中考虑自发性EDH的重要性。即使没有外伤.需要进一步的研究来阐明确切的病因，识别风险因素，并优化SCD患者这种罕见并发症的管理方法。
