Fatal Case of Acute Epidural Hematoma in an Infant With Concurrent Breath-Holding Spells.

Abstract

Objective: The coexistence of acute epidural hematoma and breath-holding spells (BHS) is infrequently encountered in clinical settings. This report presents a rare case of an infant who developed both conditions concurrently, resulting in fatality.

Case presentation: A female infant, aged 4 months and 25 days, presented to the emergency department with persistent vomiting for 15 hours and loss of consciousness for 5 hours. Computed tomography of the head indicated a substantial epidural hematoma involving the left frontal, parietal, and temporal lobes. The patient was promptly admitted to the intensive care unit for resuscitative measures and surgical preparation. Emergency decompressive surgery was performed, and postoperative supportive management, including fluid resuscitation and antimicrobial therapy, was initiated. Postoperatively, the infant demonstrated clinical improvement sufficient for ventilator weaning. However, cardiac arrest occurred within one minute of extubation. Despite immediate cardiopulmonary resuscitation, the patient did not survive.

Conclusions: The concurrence of acute epidural hematoma and breath-holding spells is a rare and potentially fatal clinical entity in infants. Mortality related to BHS remains uncommon. Early recognition, comprehensive parental education, prompt multidisciplinary intervention, and heightened clinical awareness are essential for improving prognoses in pediatric patients presenting with craniocerebral trauma complicated by BHS.