[Bradycardia as a unique sign of an increase in the extradural haematoma volume].

The commonest presentation of an extradural haematoma implies a head trauma with transient loss of consciousness followed by a lucid interval then rapid neurological degradation. Some of these haematomas including small ones with no midline shift and few neurological symptoms can be managed without surgical evacuation. Whilst clear recommendations have been issued regarding surgical indications, guidelines for medical supervision are still needed. We report a case of an eight-year-old girl who presented to our hospital emergency department with headache, vomiting but no neurological deficit, 3 hours after a head trauma without loss of consciousness. The CT-scan proved an extradural haematoma of 6mm width. The patient was monitored in paediatric reanimation and was scoped. Seventeen hours after the fall, the patient presented with severe isolated bradycardia. The CT-scan showed an enlargement of the haematoma with brain herniation, which was evacuated. Therefore, electrocardiogram abnormalities can reveal infraclinic raised intracranial pressure. Systematic continuous ECG monitoring during the first 24 to 48 hours would optimize the surgical management of this disease and then limit its morbi-mortality.