Intracranial Extradural Hematoma Research Articles

SPONTANEOUS EPIDURAL BLEED: A DIRE COMPLICATION OF SICKLE CELL CRISIS

SESSION TITLE: Case Report Semifinalists 1 SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Sickle cell disease (SCD) is caused by a single amino acid substitution on the beta globin chain resulting in the propensity of the hemoglobin molecule to polymerize in deoxygenated state. Neurologic manifestation secondary to SCD is common and affects almost 35% of patients. About 54% of these patients suffer from ischemic strokes and 34% from intracranial bleeding. Isolated non-traumatic spontaneous epidural hematoma (EDH) is an exceedingly rare complication of SCD. Other reported etiologies of spontaneous SDH are infectious, coagulation abnormalities associated with end stage renal disease and hemodialysis, dural metastasis and Langerhans cell histiocytosis. CASE PRESENTATION: A 20-year-old African American female with SCD presented with severe generalized pain. She was hypertensive, tachycardic, tachypneic with an oxygen saturation 98% on room air. Physical examination revealed poor bilateral air entry on lung auscultation due to splinting and a normal neurological examination. Blood work showed leukocytosis of 12,800 with 53% neutrophil and 1% band, hemoglobin 7.5 gm/dL, platelet 181,000/dL, reticulocyte count 13%, LDH 1144 IU/L. Liver function tests were normal except a total bilirubin level of 16.2 mg/dL. The patient was started on IV hydration, analgesia was achieved by IV narcotics. About 24 hours after hospital admission, the patient suddenly became unresponsive. An emergent CT scan of the head revealed a large right sided fronto-parietal epidural hematoma with midline shift, subfalcine and uncal herniation. No noticeable bone infarction overlying the hematoma. The patient underwent emergent hematoma evacuation but died 24 hours post-surgery. DISCUSSION: Spontaneous non-traumatic EDH is a rare manifestation of SCD. Only 30 cases have been reported in the literature. The pathophysiology is not completely understood. Three explanations have been proposed over the years. 1) Vaso-occlusion of the haematopoietically active calvarial diploic bone resulting in bone infarction and subsequent leaking of blood in the periosteal and subsequently epidural or in the subgaleal space 2) Acute rapid expansion of hematopoiesis with resultant microfracture of already thinned inner cortex and extravasation of blood and hematopoietic tissue 3) Sludging of sickle cells in the diploic veins hampering venous drainage and oozing of blood due to vascular injury and elevated back pressure.Presence of coagulopathy or platelet dysfunction is also likely responsible for hematoma expansion and worse clinical outcome. Overlying bony infarction is associated with better prognosis. CONCLUSIONS: The understanding regarding this rare disease entity is rapidly evolving in the era of advanced technology and improved awareness among health care providers. We believe this report will shed more light on the clinical as well as the pathophysiologic aspect of the disease process. Reference #1: Hettige S, Sofela A, Bassi S, Chandler C. A review of spontaneous intracranial extradural hematoma in sickle-cell disease. Acta Neurochirurgica. 2015;157(11):2025-9. Reference #2: Ohene-Frempong K, Weiner SJ, Sleeper LA, Miller ST, Embury S, Moohr JW, et al. Cerebrovascular accidents in sickle cell disease: rates and risk factors. Blood. 1998;91(1):288-94. Reference #3: Banerjee C, Yowtak J, Fridlyand D, Alleyne C, Jr. Acute spontaneous intracranial epidural haematoma and disseminated intravascular coagulation in a paediatric sickle cell patient. BMJ case reports. 2018;2018. DISCLOSURES: No relevant relationships by Hau Chieng, source=Web Response No relevant relationships by Boris Medarov, source=Web Response No relevant relationships by Biplab Kumar Saha, source=Web Response No relevant relationships by Aditi Saha, source=Web Response

Disappearance of Intracranial Extradural Hematomas: Role of Diastatic Cranial Fracture and Intracranial Pressure - An Institutional Experience.

Context:The intracranial extradural hematoma (EDH) occupies space and creates a mass effect on the brain but the tenacious-adhesions of dura to the inner table of skull counters this effect. The intracranial pressure also pushes the hematoma back while it is held by dural tensile-force.Aims:The exploitation of a diastatic fracture, overlying an EDH, by the intracranial pressures to decompress a hematoma out of extradural space into subgaleal/subperiosteal space without surgical intervention.Settings and Design:In a period of 15 years, a group of 11 patients among 729 EDHs were managed conservatively.Materials and Methods:The retrospective study of 11 EDH patients was conducted in the Department of Neurosurgery from January 2000 to December 2014 in 15 years.Statistical Analysis Used:The statistical law of variance was used as applicable.Results:Analysis of spontaneous disappearance of intracranial EDH among 11 patients revealed that only 1.5% (11/729) EDHs resolved conservatively. The most cases (63.6%) were children and the youngest being 9 months old. All the patients had a diastatic fracture overlying-EDH and were fully conscious. The cause of head injury in most was the fall from height. The hospital stay ranged from 2 to 4 days. All the patients had a good recovery at the time of discharging.Conclusion:The trial of the conservative or spontaneous disappearance of an EDH through a diastatic fracture into the subgaleal space is similar to burr-hole drainage without surgical intervention but depends upon the neurological status, the intracranial pressure of the patient, and the availability of all the modern neurosurgical gadgets.

Factors Affecting the Surgical Outcome in Extradural Hematoma in Punjab Institute of Neurosciences, Lahore, Pakistan

Head injury is a leading cause of death in young age group. Extra Dural hematoma, a complication of head injury, is often fatal if not treated in time. The surgical outcome of EDH is dependent upon many variables including preoperative GCS, time between injury and surgery, associated intracranial injuries, anisocoria and hematoma volume. In order to reduce the mortality near to nil, it is essential to determine the magnitude of effect of affecting factors on surgical outcome which will also help us in preoperative counseling and prioritizing the operative candidates. This study was conducted determine the factors affecting surgical outcome of traumatic intracranial extradural Hematoma in Punjab Institute of Neurosciences/ Lahore general hospital, Lahore. It was a Cross sectional study conducted for 3 years from 28th May 2012 to 28th May 2015.The study was conducted on the patients admitted through emergency and diagnosed as Extramural hematoma. These patients underwent surgical evacuation of EDH on emergent basis and outcome was measured by Glasgow Outcome Scale (GOS) after 48 hours of surgery. Using GOS, good surgical outcome was observed in 80.9% (157 out of 194) patients. Preoperative GCS, anisocoria, hematoma volume, associated intracranial injuries and time between injury and surgery were the factors affecting the outcome significantly (p value=0.000) while age and sex of the patient had no significant effect. In Conclusion, good surgical outcome is associated with patients with solitary Extra Dural Hematoma of volume less than 60 ml, preoperative GCS more than 8, absence of anisocoria and undergoing surgical evacuation within 6 hours of injury. Nepal Journal of Neuroscience, Volume 14, Number 3, 2017, Page: 13-18

The impact of major trauma centre implementation on the pathways and outcome of traumatic intracranial extradural haematoma in a regional centre

Introduction: A new trauma care system with regional major trauma centres (MTC) was implemented on 1st April 2012 across England. We aimed to assess whether this has affected the referral pathways and mortality of patients undergoing emergency craniotomy for extradural haematoma (EDH), where clinical outcome is correlated with the time to intervention.Materials and methods: This was a retrospective cohort comparison study. All patients who had undergone evacuation of EDH from January 2011 to December 2013 were identified. Only those in whom a decision for emergency craniotomy had been made at the time of referral to the on-call neurosurgeon were included. The CRASH predicted risk of mortality was calculated for individual patients. Mortality was assessed at 14 days in order to compute standardised mortality ratios (SMR).Results: Overall, 65 patients underwent EDH evacuation during the study period (21 pre-MTC and 44 post-MTC). Of those, 43 emergency procedures according to the aforementioned definition were included for further analysis (13 pre-MTC, 30 post-MTC). The mean CRASH predicted risk of mortality was 0.21 for the pre-MTC cohort (95% CI: 0.07–0.34) and 0.094 for the post-MTC cohort (95% CI: 0.039–0.15; p = 0.052). There was no significant difference in the rate of secondary transfers before and after MTC implementation (9/13 vs. 23/30, p = 0.71). The mean interval from referral to operation was 198 min for the pre-MTC cohort (95% CI: 123–273) and 201 min for the post-MTC cohort (95% CI: 141–262; p = 0.95). The SMR was 0.37 for the pre-MTC cohort (95% CI: 0.02–1.81; 1 death) and 0.71 for the post-MTC cohort (95% CI: 0.12–2.34; 2 deaths).Conclusions: MTC implementation has not affected the time to operation or the mortality following EDH evacuation.

Traumatic Intracranial Frontal Extradural Hematoma Associated with Orbital Subperiosteal Hematoma

Intracranial extradural hematoma (EDH) is a frequent lesion but simultaneous occurrence of EDH with orbital subperiosteal hematoma following head injury is a rare event. We report a 22 year old male who sustained head injury during road traffic accident. Glasgow coma scale was 13/15 on arrival and he had left orbital ecchymosis & subconjunctival hemorrhage. CT revealed left frontal extradural hematoma with associated orbital subperiosteal hematoma. No bone fracture was seen. The patient had good clinical recovery following surgical evacuation of the hematomas.DOI: http://dx.doi.org/10.3126/njr.v1i1.6325 Nepalese Journal of Radiology Vol.1(1): 52-53

Intracranial extradural hematoma associated to sinusitis and subdural empyema

Los editores de Revista Clínica Española (Rev Clin Esp) informan de su actuación editorial durante los últimos 12 meses (noviembre 2010 a octubre 2011): a) objetivos y consecuciones durante el año 2011; b) actividad editorial, y c) objetivos para el año 2012.Durante el año 2011 hemos perfeccionado el algoritmo editorial (evaluación por un editor de cada manuscrito enviado a revisores externos y creación de la figura de la «coordinadora editorial»), renovado los dos órganos consultivos («consejo editorial y consejo científico»), implantado la sección «imagen del mes», y se han concedido por primera vez los premios anuales Rev Clin Esp.Entre el 1 de enero y el 31 de octubre de 2011 se han gestionado 422 manuscritos (42,2 manuscritos/mes), cifra algo superior a la del año 2010 (40,4 manuscritos/mes), de los cuales han sido aceptados un 25,6% (originales, 16%). Hemos cursado 343 solicitudes de evaluación a 231 revisores, siendo aceptadas 185 de ellas. El 72% de los revisores enviaron sus comentarios en menos de dos semanas (tiempo medio de recepción de revisiones: 11 días). El tiempo medio para adoptar una decisión editorial definitiva (aceptado o rechazado) ha sido de 26 días. El tiempo medio transcurrido desde la fecha de remisión hasta la de publicación de los originales (números de septiembre, octubre y noviembre) ha pasado de 334 días en el 2010 a 254 en el 2011 (reducción del 24%). La participación de los grupos de trabajo de la Fundación Española de Medicina Interna (FEMI) ha sido próxima a dos manuscritos/número.Para el año 2012 hemos establecido los siguientes objetivos: a) mejorar el proceso de edición; b) traducir al inglés los artículos principales; c) actualizar algunas secciones (p. ej., conferencia clínica); d) incentivar la colaboración de los grupos de trabajo, y e) mejorar la formación médica continuada. Revista Clínica Española es un foro abierto a la contribución de todos los internistas. A todos nos cabe la responsabilidad de colaborar para que nuestra revista sea, cada día, un poco mejor.The editors of Revista Clínica Española (Rev Clin Esp) inform on their editorial activity during the last 12 months (November 2010 to October 2011): (a) Objectives and attainments during 2011, (b) editorial activity, and (c) objectives for 2012. In 2011 we have updated the editorial algorithm (revision by the responsible editor of all manuscripts sent to peer review and incorporated an «editorial coordinator»), we have renovated two advise facilities (editorial and scientific committees), we have created a new section called «monthly e-image», and we have promoted Rev Clin Esp annual prizes.From the first January 2010 to 31st October 2011 we handled 422 manuscripts (42,2 manuscripts per month, higher than the 2010 figure of 40,4 manuscript/month). Overall we have accepted 26% (originals, 16%). We asked for 343 revisions and obtained 231 (67%). Seventy two percent of the reviewers sent their comments in less than two weeks. The mean time taken to accept or reject a given manuscript has been 26 days. The mean time taken since a manuscript is received to publication (october, novembrer and december issues) has dropped from 334 days in 2010 to 254 in 2011 (24% decrease). The collaboration with the working groups has reported about 2 published manuscripts per issue.Our objectives for 2012 are: (a) to improve the editorial process; (b) main article translation into English; (c) improve some sections (i.e. clinical conference); (d) estimulate working groups collaboration; and (e) improve continued medical education. Revista Clínica Española is an open forum for all internal medicine specialists. We all have the responsibility to make our journal, each day, better.

Spontaneous intracranial extradural haematoma associated with frontal sinusitis and orbital involvement

Intracranial extradural hematoma is usually traumatic. Rarely, it can occur spontaneously associated with coagulative disorders (spontaneous or iatrogenic), dural vascular malformation, cranio-facial tumors and infections. In these cases, spontaneous extradural hematoma (SEH) is a serious event that needs to be recognized and managed in time to avoid fatal outcome. The authors report a case of a 12-year-old young girl with a 3-year history of right frontal sinusitis treated urgently for a right frontal extradural hematoma involving the orbit. Diagnosis and management of this case is discussed reviewing the pertinent literature.

Is management of spontaneous intracranial extradural hematoma in chronic renal failure is different with traumatic extradural hematoma — Case report and review of literature

Intracranial extradural hematoma is commonly associated with head trauma. Spontaneous EDH is a rare entity and associated with various co morbid conditions. Chronic renal failure (CRF) is one of them. In case of CRF, spontaneous EDH has been reported in those patients who were either on hemodialysis or had long history of CRF. We report a case of concurrently asymptomatic chronic renal failure that developed spontaneous EDH with neurological deficits and during investigation, diagnosed to have acute on chronic renal failure. Investigation and management is discussed in the report.

Pathological intracranial extradural hematoma in a 10-year-old child

A nontraumatic spontaneous extradural hematoma, in a fully conscious 10-year-old male child, caused by a solitary eosinophilic granuloma of calvarium presented as a case of localized painful swelling of the head, which rapidly expanded and decreased in size. A plain CT-scan of the head with bone window revealed eroded right parietal bone with subperiosteal debris and extradural hematoma of mixed density. Immediate evacuation of the extradural clot and complete excision of the lesion was performed to prevent the deterioration of the patient and to achieve the histological diagnosis for further management.

Spontaneous intracranial extradural hematoma: Case report and literature review

Spontaneous extradural hematoma (EDH) is an uncommon form of intracranial hematoma and is caused by the adjacent sinus and otic infections, dural vascular malformations and disorders of blood coagulation. We report spontaneous EDH in a 54-year old women with chronic kidney disease (CKD) on intermittent hemodialysis. She was successfully managed by conservative treatment. The EDH in her was probably related to the coagulation abnormalities associated with CKD, hemodialysis or heparin use during the dialysis.

Diagnosis and Treatment of Orbit Posttraumatic Subperiosteal Hemorrhage in a Child, Associated with a Subdural Intracranial Hemorrhage

We describe a rare case of traumatic subperiosteal orbital hematoma in a child, with intracranial hemorrhagic complication. Subperiosteal hematoma are the more infrequent occurrences among intraorbital hemorrhagic lesions and can be also associated with intracranial extradural hematoma in patients with orbital roof fracture. Here, we describe a case without roof fracture but with a never-before described intracranial subdural hematoma. The patient underwent computed tomography and magnetic resonance imaging, in an acute state, and later, a radiologic diagnosis of percutaneous drainage of the hematoma was mad. MRI was more sensitive and specific in the evaluation of the intracranial and intraorbital complication.

Cauda equina syndrome caused by delayed traumatic spinal subdural haematoma

Spinal subdural haematoma (SDH) is rare and may be associated with blood dyscrasia [1], anticoagulant therapy [2], lumbar puncture [3], rupture of arteriovenous malformation [4], tumour bleeding [5,6] and spinal trauma [7–9]. This is a report of a head injury with an acute intracranial extradural haematoma. The patient recovered well after a craniotomy but presented with a cauda equina syndrome due to the delayed onset of spinal subdural haematoma two weeks after the accident.

Prognosis of extradural haematomas in children.

102 children treated surgically for intracranial extradural haematoma from 1982 to 1991 were evaluated retrospectively and their prognosis was compared with 387 adults treated during the same period. Children had a better prognosis than adults even with a low Glasgow Coma Scale (GSC) score at surgery. Children had a higher incidence of frontal and posterior fossa haematomas. The GCS score and the associated parenchymal injuries had a strong correlation with the outcome both in adult and children, whereas the site of haematoma had no correlation with the final outcome.