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Nascer e Crescer
versão impressa ISSN 0872-0754
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CARVALHO, Marisa et al. Subdural hematoma in pediatrics - Early diagnosis and treatment. Nascer e Crescer [online]. 2011, vol.20, n.2, pp.76-78. ISSN 0872-0754.
Introduction: Non-traumatic acute subdural hematoma is a rare entity in children. In the presence of acute neurological symptoms associated with long termanticoagulation, it is mandatory to rule out this entity. Case report: We report the case of a seven-year-old boy, with mechanical mitral valve prosthesis under warfarin treatment, presenting severe and progressive headache associated with altered level of consciousness and seizures. Laboratory studies revealed a high value of International Normalized Ratio(INR: 4,2). He was admitted to the Pediatric Intensive Care Unit in a coma with anisocoria. He was mechanically ventilated and started on specific measures to reduce cerebral edemain addition to anticonvulsants. Cranial computerized tomography (CT scan) revealed acute left subdural hematoma, with midline shift. Fifty-six hours after the onset of symptoms, he was submitted to decompressive craniectomy. There was progressive clinical recovery with neurological and imaging improvement and an excellent outcome. Discussion: This case illustrates the importance of the clinical suspicion of a subdural hematoma in patients treated with anticoagulants, as well as the need of optimizing surgical conditions and the use of non invasive techniques for monitoring the level of consciousness.
Palavras-chave : anticoagulation; congenital heart disease; subdural hematoma.