Large Extradural Hematoma Research Articles

An adolescent with large extradural hematoma and undiagnosed congenital cyanotic heart disease at wee hours: An anesthetist's nightmare

Extradural hematoma (EDH) is a life-threatening emergency, which needs emergent evacuation to prevent mortality and morbidity. We report a case of an adolescent, who had large fronto-temporo-parietal EDH, with significant midline shift, and was incidentally diagnosed to have congenital cyanotic heart disease with deranged coagulation profile in the preoperative area using point-of-care ultrasound.

Reappraisal of the causes of spontaneous epidural hematomas: A case after stent-assisted coiling for ruptured posterior communicating artery aneurysm

Abstract We presented a rare case of delayed spontaneous epidural hematoma (EDH) occurring as a complication of stent assisted coiling of a ruptured intracranial aneurysm. We reported a 60-year-old woman with diagnosed ruptured aneurismal subarachnoid hemorrhage with large wide-necked aneurysm of the left posterior communicating artery. After stent assisted coil embolization, dual-antiplatelet therapy was administered. On the 11th day after coiling, she suffered from decreased mentality and dysarthria. Follow-up brain CT scan revealed a large extradural hematoma on the left frontal area which required an emergency hematoma removal. The present report emphasizes the fact that lumbar drainage procedure with anticoagulant, after stent assisted coil embolization, can cause life threatening hemorrhagic complications and requires immediate diagnosis and treatment.

Coiling of central venous catheter in right internal jugular vein.

Sir, We read with interest the article written by Goyal et al.[1] describing a case of coiling of central venous catheter (CVC) in left subclavian vein. The authors have reported it as a rare complication, and we do not agree with this statement. Malatinský et al.[2] in 1976 presented a series of 378 radiographically controlled CVC placements and reported pure loop formations (coiling) in 2.9% of the cases. Supraclavicular subclavian approach was used in the majority of the patients and the authors explain this as a reason for relatively low incidence rates in their series as compared to other studies.[2] We report a case of coiling of central venous catheter in right internal jugular vein (IJV) in a 36-year-old patient admitted postoperatively in intensive care unit (ICU) following evacuation of large extradural hematoma. The CVC was placed in the operation theatre under ultrasound guidance. Intraoperatively the waveform was damped, and the flow of fluids was slow, but it was considered secondary to rotation of the neck and labeled as “positional”. Just after admission to the ICU a “flush test” was performed, and it was positive; 5–10 mL of normal saline was injected with force using a syringe and fluid thrill was felt in the ipsilateral neck region with the palmer aspect of the hand.[3] Subsequent chest X-ray confirmed coiling of CVC in right IJV [Figures ​[Figures1a1a and ​andbb]. Figure 1 (a) Chest X-ray anteroposterior view with coiled central venous catheter in right internal jugular vein, (b) Coiled central venous catheter after removal Factors predisposing to coiling and catheter malpositions are: Retrograde venous flow secondary to IJV valve incompetence in patients with chronic obstructive pulmonary disease, primary pulmonary hypertension and prior cannulations and catheterizations of the IJV[4,5] Retrograde venous flow in patients with high intrathoracic and intrabdomical pressures Seldinger technique: The catheter is inserted over the guidewire and placed in the central vein. During this procedure sometimes the guidewires are removed before the CVC are properly positioned in the superior vena cava. Resistance encountered in inserting the CVC then leads to excessive pressure applications, which then predisposes to malpositioning. Common sites of resistance are the junction of first rib and clavicle for the subclavian vein and the junction of venous tributaries for the IJV and brachiocephalic vein.

Presentation of a minimally symptomatic large extradural hematoma in a patient with an arachnoid cyst: a case report and review of the literature

IntroductionHemorrhagic complications of arachnoid cysts have been reported, extensively presenting with subdural or intracystic hematoma after trauma, but presentation with extradural hemorrhage is very rare. In this paper, we report the case of a patient with an arachnoid cyst who developed an extradural hematoma after a subtle head injury. Our patient presented with very mild symptoms in spite of the very large size of the hematoma.Case presentationOur patient was a 23-year-old Iranian man who complained of diffuse progressive headache and vomiting after mild head trauma. A brain computerized scan showed a very large extradural hematoma in the left frontotemporoparietal convexity over a large arachnoid cyst.ConclusionBrain parenchyma containing an arachnoid cyst is vulnerable to trauma and increases the risk of serious hemorrhagic complications. We also suggest that the abnormal shape of the head should be considered as an indication for a computerized tomography scan in cases of mild head injury.

Bilateral cortical atrophy after severe brain trauma and extradural homatoma

We report the case of a severe head injured 43-year old male patient with a large extradural hematoma, Glasgow Coma Scale 3 and dilated fixed pupils. Patient was promptly submitted to surgical evacuation of the lesion, but remained in persistent vegetative state in the post-operative time. Head computed tomography scans performed before surgery, and at early and late post-operative periods comparatively revealed extreme bilateral cortical atrophy. Late consequences of severe head trauma drastically affect the prognosis of patients, being its prevention, and neuroprotection against secondary injury still a therapeutical challenge for neurosurgeons.

Vertex extradural hematoma in association with Paget′s disease of the skull

Paget's disease of skull usually causes neurological complications such as basilar invagination, cranial neuropathies, etc. Occurrence of extradural hematoma in association with Paget's disease of skull is rare. A 48 year old man presented with headache and right upper limb weakness, two days after a fall from scooter. CT Scan of brain showed a large extradural hematoma at the vertex with the cranial vault showing features of Paget's disease. At surgery, no skull fracture or injury to the superior sagittal sinus was evident. There was diffuse oozing from the inner table of the skull, which showed features of Paget's disease. The extradural hematoma was evacuated and the patient made good recovery. He deteriorated a few hours after surgery. Follow up CT Scan showed diffuse brain swelling with minimal recollection of hematoma. Re-exploration showed a small recollection which was evacuated and the part of the oozing diseased skull was excised. The patient recovered completely. This is the first reported case of vertex extradural hematoma in association with the Paget's disease of skull. The unusual features are the absence of skull fracture and injury to the superior sagittal sinus. The increased vascularity of the skull due to Paget's disease has caused the hematoma by diffuse oozing from the inner table.

Intracisternal recombinant tissue plasminogen activator after aneurysmal subarachnoid hemorrhage

Fifteen patients undergoing surgery within 48 hours of aneurysm rupture were administered recombinant tissue plasminogen activator (rt-PA) directly into the basal subarachnoid cisterns after minimal surgical clot removal and aneurysm clipping. Preoperatively, 13 patients had diffuse or localized thick subarachnoid blood clots on computerized tomography (CT), and two had diffuse thin clots. The rt-PA was given as a single intraoperative injection of 7.5 mg (one patient), 10 mg (nine patients), or 15 mg (five patients). Postoperative cisternal drainage was employed in three patients. All patients except one demonstrated partial to complete cisternal clot clearance on CT scans within 24 hours after surgery. The patient who showed no clot reduction was the only patient in this series to develop symptomatic vasospasm and was the only fatality, dying 8 days after rupture. No vasospasm was seen on follow-up cerebral angiography in six of the 14 responding patients, and mild-to-moderate arterial narrowing was seen in at least one major cerebral artery in the remaining eight patients. Severe angiographic vasospasm was not seen, although the patient who died did not undergo repeat angiography. There was one major complication early in the series which seemed clearly related to treatment, and that was a large extradural hematoma occurring within several hours of craniotomy. Intrathecal fibrinolytic treatment appears effective in clearing subarachnoid clot and reducing vasospasm, and may be associated with acceptable risks if given to patients with large-volume subarachnoid hemorrhages at high risk for severe vasospasm.

新生児急性硬膜外血腫に対する外科的治療法の検討

Two cases of acute epidural hematoma in neonates are reported. They were full-term babies delivered by vaginal vertex with the aid of forceps in one case and an evacuum extractor following a difficult labor in the other. CT scanning revealed multiple extradural hematomas in the left frontoparietal and the right parietal regions in Case 1, in which the infant presented with persisting tonic clonic convulsions, and a single large extradural hematoma in the right parietal region in Case 2, in which the infant presented with disturbance of consciousness. Good recovery was achieved following surgery in both cases. Twenty reported cases including ours are reviewed and indications for surgery of extradural hematoma in infants are discussed. Acute extradural hematomas in the neonate are divided into three types, depending on the site and extension of the hematoma. For type 1a with a single supratentorial solid hematoma, type 2 with multiple supratentorial hematomas, and type 3 with an infratentorial hematoma, showing severe symptoms like convulsion, respiratory distress and disturbance of consciousness, surgical treatment is indicated. For type 1b with a single supratentorial liquid hematoma communicating with a cephalohematoma, aspiration by needle puncture may be tried, and conservative management might be possible.

Importance of angiography in identifying false aneurysm of the middle meningeal artery as a cause of extradural hematoma. Case report.

Received for publication May 14, 1968. parieto-occipital region. Internal carotid angiograms revealed an extracerebral hematoma (Fig. 1). First Operation. A burr hole over the suspected area disclosed a large extradural hematoma. I t was evacuated, apparently completely. No definite source of bleeding was found. First Postoperative Course. The patient regained consciousness the following morning; the paresis and dysphasia were little improved. To investigate the cause of the incomplete recovery, selective external carotid angiography was done on the 8th postoperative day; it revealed a false aneurysm of the posterior branch of the middle meningeal artery (Fig. 2) . Second Operation. A small bone flap centered over the site of the false sac was raised. Evacuat ion of the underlying residual clot exposed the bleeding artery; the hemor-