Vertex extradural haematomas: a report of 3 cases and a review of the literature

Abstract

Extradural haematomas occurring at the vertex are an unusual group of a common condition. Their clinical presentation is frequently atypical and the diagnosis often delayed. The clinical findings do not always correlate with the site of the lesion and venous engorgement due to impaired venous drainage is the likely explanation. Nearly all cases will have a fracture crossing the vertex but this may go undetected as skull X-rays are frequently not performed in acute trauma and the vertex is a difficult area to visualize with conventional axial computed tomography (CT) scanning. Magnetic resonance image (MRI) scanning is the investigation of choice but is rarely available in acute trauma. Patients may present in an acute, subacute or chronic fashion. The treatment can be surgical or non-surgical depending on the neurological condition of the patient. Most patients make an excellent recovery.