Abstract
Background: Pediatric extradural hematoma (EDH) management is traditionally dictated by volumetric thresholds, with evacuation recommended for collections >30 mL. However, the unique compliance of the young child's cranium can allow for atypical clinical stability despite massive internal haemorrhage.
Case Description: A 2-year-old boy presented with a 100 mL EDH following a minor fall. Despite the volume, the child remained neurologically intact (GCS 15). Managed conservatively, the hematoma demonstrated a rapid 40% volume reduction within 24 hours.
Conclusion: This case illustrates the “redistribution phenomenon,” where extradural blood vents into the subgaleal space via patent sutures. We argue that in neurologically stable children, the mechanism of auto-decompression should weigh more heavily than static volumetric measurements in surgical decision-making.
