Traumatic Epidural Hematoma Research Articles

Vertex epidural hematoma-neuroradiological findings and management: A case report

Epidural hematomas occurring at the vertex are uncommon, and they can be difficult to diagnose by axial CT. We report a case of acute traumatic vertex epidural hematoma, which resolved spontaneously with time. We stress the importance of MR investigations in this diagnostic challenge.

Possible Mechanisms for Rapid Spontaneous Resolution of Acute Epidural Hematomas

Background: Acute epidural hematomas (EDH), often associated with additional cranial and extracranial injury, are a serious condition which requires immediate surgical evacuation. Otherwise there is a high risk of quick deterioration and death. Only small asymptomatic hematomas can be treated conservatively with close observation. Case Report: We present a case of complete resolution of a traumatic posterior fossa EDH within 1 hour. Conclusion: Several possible mechanisms of spontaneous resorption are discussed with a review of literature regarding the conservative treatment of acute epidural hemorrhage. This is the first description of the spontaneous resolution of an acute traumatic EDH within 1 hour.

Spinal epidural haematoma: MRI-aided diagnosis

Spinal epidural haematoma is a rare cause of spinal cord compression. It is most commonly attributed to trauma and coagulation disorders. We report a case of a 64 year-old man with thrombocytopaenia who presented with a traumatic epidural haematoma who p resented with right hemiparesis which progressed to complete tetraplegia. MR of the cervical spine showed an epidural collection on the posterior aspect of the cord throughout the cervical spine. The patient underwent C1–C7 laminectomy and decompression. Postoperatively, the patient has improved gradually and has power of grade 3 (Medical Research Council classification of power) in all 4 limbs at 2-month follow-up. MRI is an important modality in the early diagnosis of spinal epidural haematomas and can facilitate emergent decompressive surgery which off ers the best chance of neurological improvement.

Postcontrast Magnetic Resonance Imaging to Predict Progression of Traumatic Epidural and Subdural Hematomas in the Acute Stage

Postcontrast Magnetic Resonance Imaging to Predict Progression of Traumatic Epidural and Subdural Hematomas in the Acute Stage

Traumatic Epidural Hematoma of the Cervical Spine: Magnetic Resonance Imaging Diagnosis and Spontaneous Resolution: Case Reports

Traumatic Epidural Hematoma of the Cervical Spine: Magnetic Resonance Imaging Diagnosis and Spontaneous Resolution: Case Reports

Traumatic Epidural Hematoma of the Cervical Spine: Magnetic Resonance Imaging Diagnosis and Spontaneous Resolution: Case Report

Traumatic Epidural Hematoma of the Cervical Spine: Magnetic Resonance Imaging Diagnosis and Spontaneous Resolution: Case Report

Case study: Epileptic falling spells after epidural haematoma in adult Down's syndrome

A 35-year-old man with Down's syndrome showed epileptic falling spells. He had suffered from a traumatic right-sided epidural haematoma 3 years before. It had been neurosurgically treated, but MRI taken 5 days later had revealed a small contracoup contusion at the left temporal lobe. His falling spell was a brief tonic seizure without disturbance of consciousness. Background activities of EEG consisted of slow alpha waves interspersed with sporadic theta waves and the amplitude at the left temporal area was lower than the opposite one. Interictal EEG showed sharp waves or sharp and slow wave complexes predominantly at the right temporo-centro-parietal area as well as diffuse, though predominantly at frontal areas, bursts of slow waves with high amplitude. The EEG suggested focal epileptic activities evolving into secondary generalization. SPECT of the brain showed the hypoperfusion at the left temporal area and at the right posterotemporo-parietal area, where the hypoperfusion was somewhat reduced after the improvement of seizures. Seizures were well controlled with phenytoin combined with phenobarbital. The incidence of epilepsy in the Down's syndrome has been reported to increase after the middle age in association with the development of Alzheimer's neuropathology. When those people would sustain head injuries, it was necessary to follow carefully using SPECT and EEG.

Postcontrast magnetic resonance imaging to predict progression of traumatic epidural and subdural hematomas in the acute stage.

We investigated the possibility of predicting the progression of traumatic epidural hematomas (EDHs) and subdural hematomas (SDHs), in the acute stage, by using postcontrast magnetic resonance imaging (MRI) with gadolinium-diethylenetriaminepentaacetic acid. From January 1990 through December 1996, 41 patients with 43 hematomas (21 EDHs and 22 SDHs) underwent postcontrast MRI within 24 hours after injury. T1-weighted MRI was performed by using the spin echo method, after the administration of 0.1 mmol/kg gadolinium-diethylenetriaminepentaacetic acid, immediately after computed tomographic scanning. All of the enhanced hematomas were enlarged, whereas nonenhanced hematomas, except for two SDHs with bleeding tendencies, remained unchanged or decreased in volume. The prediction rates for enlargement with this method were 100% (21 of 21) for EDHs and 91.0% (20 of 22) for SDHs. The sensitivity of this test in predicting enlargement was 100% (15 of 15) for EDHs and 81.8% (9 of 11) for SDHs. The specificity was 100% for both types of hematomas. The enlargement rates for diffusely enhanced hematomas were statistically greater than those for nonenhanced hematomas. All of the patients with diffusely enhanced hematomas, which were found during surgery to exhibit active bleeding points, experienced consciousness deterioration. We conclude that diffuse enhancement indicates extravasation from broken vessels that continue to bleed and that diffusely enhancing hematomas will be rapidly enlarged. We think that postcontrast MRI can be very useful for predicting the progression of acute EDHs and SDHs.

Postcontrast Magnetic Resonance Imaging to Predict Progression of Traumatic Epidural and Subdural Hematomas in the Acute Stage

Postcontrast Magnetic Resonance Imaging to Predict Progression of Traumatic Epidural and Subdural Hematomas in the Acute Stage

Postcontrast Magnetic Resonance Imaging to Predict Progression of Traumatic Epidural and Subdural Hematomas in the Acute Stage

Postcontrast Magnetic Resonance Imaging to Predict Progression of Traumatic Epidural and Subdural Hematomas in the Acute Stage

Postcontrast Magnetic Resonance Imaging to Predict Progression of Traumatic Epidural and Subdural Hematomas in the Acute Stage

Postcontrast Magnetic Resonance Imaging to Predict Progression of Traumatic Epidural and Subdural Hematomas in the Acute Stage

Prognosis and clinical relevance of anisocoria-craniotomy latency for epidural hematoma in comatose patients.

To determine whether the time between onset of anisocoria and surgery for hematoma evacuation in the head-injured patient is a useful prognostic variable for outcome in the comatose patient with an acute epidural hematoma. Prospective. Twenty-one patients with an acute traumatic epidural hematoma and an admission Glasgow Coma Scale score of less than 8 were analyzed. Anisocoria was present in 14 (67%) patients. Mortality rate was three times higher in this group than in the patients without anisocoria; however, this difference was not statistically significant (p = 0.21, Fisher's exact test). None of the patients with an anisocoria-craniotomy latency of 70 minutes or less died and all of these patients had a good or reasonable outcome. Analysis of the anisocoria-craniotomy latency in ten patients revealed that a lapse of more than 90 minutes was associated with a greater mortality compared with patients with a latency of less than 90 minutes (p = 0.0238, Fisher's exact test). In patients with an acute epidural hematoma, reducing the anisocoria-surgery interval below 90 minutes is significantly associated with a better outcome (p = 0.0238, Fisher's exact test).

Acute cervical epidural haematoma after soft-tissue cervical spine injury

A soft-tissue cervical spine strain (colloquially known as a ‘whiplash injury) is a common cause of morbidity after road traffic accidents. However, the underlying soft-tissue damage is poorly understood’. When examination and investigations show no abnormality there is a tendency to associate symptomatic patients with on-going litigation rather than significant pathology’ Traumatic cervical epidural haematomas (EDH) have not been reported in association with a human ‘whiplash injury. We present a case where the haematoma resolved spontaneously and outline the role of magnetic resonance imaging in (MRI) in making the diagnosis.

Epidural hematomas in children

To describe the presentation, management, and outcome of children with traumatic epidural hematoma. Retrospective chart review. Fifty-three children diagnosed with traumatic epidural hematoma on computed tomography scan who were treated at Children's Hospital in Boston between 1980 and 1990. Twenty-four of 53 children developed an epidural hematoma after a fall of less than 5 ft. At the time of diagnosis, 51 of 53 children had one or more symptoms of vomiting, headache, or lethargy. Twenty-six patients were alert, 21 were responsive to verbal or painful stimuli, and five were unresponsive or posturing. Twenty-one (40%) had acute neurologic deterioration before surgery; however, 20 (38%) were alert with normal vital signs and neurologic examinations at diagnosis. All patients survived, and at the time of discharge 45 had normal examinations and eight had neurologic abnormalities; at follow-up only four of these eight had persistent (although mild) abnormalities. Although often dramatic in presentation, epidural hematoma may occur after relatively minor head trauma and in alert children with nonfocal neurologic examinations. In our study, incidence of neurologic sequelae increased if abnormal neurologic examination or depressed mental status was present at diagnosis. The outcome of children in this study is improved from that of previous studies, perhaps due to increased use of computed tomography and higher incidence of low- or moderate-impact trauma in this series.

The Expectant Treatment of “Asymptomatic” Supratentorial Epidural Hematomas

Seventy-four patients with a traumatic epidural hematoma (EDH) and a Glasgow Coma Scale score of more than 12 received expectant treatment; 14 subsequently underwent surgical evacuation of the EDH. A patient with initial brain computed tomograms (CT) showing an EDH volume of more than 30 ml, a thickness of more than 15 mm, and a midline shift beyond 5 mm tended to require surgery within 3 days of the injury when the brain had exhausted its compensatory mechanism and yielded to the expanding EDH. After the 3-day period, in the absence of neurological symptoms, the presence of the EDH may not be an indication for surgical evacuation or hospitalization beyond 7 days. In our patients, the presence of a skull fracture in the temporal bone, the heterogeneous density of the EDH in the CT scan, or the 6-hour period between the CT study and the injury did not significantly increase the failure rate of nonsurgical treatment. Although a zero mortality was achieved in this series, these guidelines may not be applicable to the management of an infratentorial EDH.

The danger of an ultra-early computed tomographic scan in a patient with an evolving acute epidural hematoma

A case of an acute traumatic epidural hematoma that developed after an ultra-early computed tomographic scan of the head is discussed. Serial neurological examinations in patients with head injuries are recommended.

The Danger of an Ultra-Early Computed Tomographic Scan in a Patient with an Evolving Acute Epidural Hematoma

Abstract A case of an acute traumatic epidural hematoma that developed after an ultra-early computed tomographic scan of the head is discussed. Serial neurological examinations in patients with head injuries are recommended.

Epidural hematoma: An unusual presentation

The authors present a patient with a traumatic epidural hematoma who complained only of headache and presented to the emergency department 48 hours after a fall. Mental status and neurological examination were normal. This delayed presentation is more commonly seen when a subdural hematoma is present but may result from epidural bleeding. Delayed formation of a traumatic epldural hematoma may occur when the following are present: elevated intracranial pressure, hypovolemic shock, a concomitani mass lesion, coagulopathy, bleeding from dural or diploic veins, a dural sinus laceration, a traumatic pseudoaneurysm, or an arteriovenous fistula. Although criteria for computed tomography of patients with head injuries remain variable in the literature, delayed presentation of epidural bleeding must be considered in the differential diagnosis of posttraumatic headache irregardless of the time interval or neurological presentation.

Delayed onset of traumatic epidural hematoma.

Over 36 months, 16 cases of delayed onset of traumatic epidural hematoma have been collected in our hospital. A negative CT finding was recorded on arrival and repeated CT scans obtained following neurological deterioration of the patients revealed sizable epidural hematomas. The occurrence of delayed epidural hematoma was more frequent in our series than previously reported. The most significant predisposing factors were skull fracture and relief of intracranial pressure. All patients received surgical management. Prognosis of these patients was directly related to the promptness with which the hematoma was removed once neurological compression began.

CT evolution of an acute venous epidural hematoma

Acute traumatic epidural hematoma may develop secondary to an arterial or venous bleed. The computed tomography (CT scan) appearance of the hematoma depends on the source and severity of bleeding, the interval between injury and CT scan, and the degree of clot organization or breakdown. We report the emergency evaluation, CT scan evolution, and clinical management of one such acute venous epidural hematoma.