A case of traumatic periventricular hematoma evaluated by CT in a child

Cases of intraventricular hematomas originating in the choroid plexus have been less frequently reported (about 1.9% of the total) than subependymal bleedings in autopsy studies [1, 2]. It is important to demonstrate pathological findings in childhood showing nonfocal minimal symptoms during the posttraumatic period. The patient we managed was a 2-year-old boy who had been born at term of a normal delivery. The patient's past history indicated a tendency to use his left hand rarely. On 9 December, 1983, while he was playing, he fell to the ground from a 3 m height, landing on his back. At that time he reportedly struck his occipital region. He vomited once 5 h after the trauma and was then admitted to an emergency clinic. His general condition was normal and no focal signs of neurological state were noted. No fractures were detected on plain skull radiographs. Because of vomiting without focal signs, CT examination was carried out. An oval-shaped area of high density, 12.9x 9.6 ram, was shown, located adjacent to the medial wall of the left lateral ventricle just above the thalamic level. These findings suggested that the hematoma originated from the medial periventricular area of the lateral ventricle. The ventricular and subarachnoid systems were clear, except for this high density area. No rupture of the hematoma into the lateral ventricle was suspected from CT scan. The size of the ventricles was normal. Neither contused lesions nor hemorrhages in the brain were observed. For 4 days he vomited once a day, just after crying, and then was discharged because of the cessation of vomiting. A second examination by CT scan on 31 January of the next year showed that the high density area in the left ventricle had completely disappeared. No abnormal findings were observed. The patient's condition has remained good since then. The prognosis of intraventricular hematomas secondary to head trauma has been variably reported. De Villasante et al. [3] reported that the frequency of observed intraventricular hematoma has greatly increased since the CT scanner has become