Abstract
Vertex epidural hematomas (VEHs) are rare and account for 1 to 8% of all epidural hematomas (EDHs). The clinical picture of VEH is variable and nonspecific, and presentation with quadriparesis is very rare. A 60-year-old man presented after head injury to emergency department with quadriparesis and unconsciousness. His Glasgow Coma Score was E1V1M5 and motor power in the right upper limb was 3/5. Power in the rest B/L lower limb and left upper limb was 0/5. Cervical spine was stabilized. CT head revealed large epidural hematoma present over the vertex with bilateral parietal contusion and skull fracture. CT cervical spine was normal. The patient was taken for emergency surgery and EDH evacuated. His Glasgow Coma Score improved to E4V5M6 over the next 2 days and power improved to 3/5 in all four limbs within 3 days and later on to 4+/5 by the time of discharge at 15 days. In the postoperative period, after the patient's clinical status stabilized, he underwent screening MRI of the spine, which was normal. In conclusion, VEHs should be considered as a possibility in patients of TBI with quadriparesis, especially when the spine is normal.
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