Acute contrecoup epidural hematoma that developed without skull fracture in two adults: two case reports

Abstract

BackgroundThe incidence of acute epidural hematoma not accompanied by fracture is low, and it mostly occurs right below the impact point in children. Acute epidural hematoma on the contralateral side of the impact point without fracture is very rare.Case presentationCase 1: a 52-year-old Japanese woman fell and was bruised in the left occipital region, and acute epidural hematoma developed in the right frontal region. No fracture line was observed in the right frontal region on head computed tomography or during surgery, and the source of bleeding was the middle meningeal artery. Case 2: a 56-year-old Japanese man fell down the stairs and was bruised in the right occipital region, and acute epidural hematoma developed in the right occipital supra- and infratentorial regions and left frontal region. Separation of the lambdoid suture was noted in the right occipital region, but no fracture line was present in the left frontal region on either head computed tomography or during surgery, and the source of bleeding was the middle meningeal artery.ConclusionsTwo rare cases of frontal contrecoup acute epidural hematoma without facture near the hematoma were reported. It is possible that the dura mater detaches from the inner surface of the skull due to cavitation theory-related negative pressure and blood vessels in the dura mater are damaged, causing contrecoup acute epidural hematoma even though no fracture occurs, for which careful course observation is necessary.

Pediatric acute epidural hematoma caused by contrecoup injury: illustrative case

“… 9 Among the 27 cases of contrecoup AEDH reported so far, only three pediatric cases have been reported ( Table 1 ). 1 This is the first case to be described in English.…”

“…Even in adults, only 27 cases of contrecoup AEDH have been reported so far, making it a rare condition. 1 , 6 , 7 , 8 Unlike coup AEDH, it is more common in women in their 50s to 60s and is characterized by a high frequency of frontal hematoma formation. 9 Among the 27 cases of contrecoup AEDH reported so far, only three pediatric cases have been reported ( Table 1 ).…”

“…Acute epidural hematoma (AEDH) is more common in young people, with most being found between 10 and 20 years of age. 1 It is usually caused by injury to the middle meningeal artery (MMA) or venous sinus with a fracture line directly beneath the bruise, but hematomas are less likely to occur in children due to strong adhesion of the dura to the endoneurial plate, especially in infants under 2 years of age. In addition, the anatomical dural vascular groove is underdeveloped and shallow, and the MMA is not buried in the bone until the age of 2 years, resulting in less damage from fractures.…”

Contrecoup epidural hematoma: a rare case report

“…EDH is responsible for 1% to 3% of all head injury incidences. It progresses just under the point of impact and is followed by a linear fracture in most occurrences; however, cases without fracture account for 10% to 20% [ 4 ]. The fatality rate ranges from 10% to 40%; in addition, it is an index of vigilance and adeptness of health care and hospital setups.…”

“…EDH may also have a venous origin, if not from diploic veins, it is from connecting fracture on their course into venous sinuses. These lower-pressure hematomas progress more moderately; in addition, are generally self-limited, however, no credible imaging indications can be applied to aid in their estimation, and this subtype ought to be categorized as malignant [ 4 , 5 ]. EDH adopts a lens-shaped of biconvex morphology since the periosteal layer of dura is peeled from the inner table of the skull by blood discharging [ 1 , 6 ].…”