Chronic epidural hematoma presenting with diplopia

Lim, Jaims; Housley, Steven B.; Drumsta, Douglas; Spiro, Richard

doi:10.25259/sni_480_2021

Cited by 2 publications

(1 citation statement)

References 18 publications

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“…Furthermore, the epidural hematoma will start the ossification process 2 weeks after the injury. Without any treatment, this collection will become a mass that appears hyperdense on a CT scan [6]. Also, the incidence of lowintensity T2*-weighted images and bone erosions on computed tomography may help differentiate rare spinal chronic epidural hematoma (CSEH) from other lumbar degenerative diseases and epidural masses on MRI [7].…”

Section: Introductionmentioning

confidence: 99%

Chronic epidural hematoma: a systematic review and meta-analysis

Agada¹,

Bankole²,

Dossou³

et al. 2023

Egypt J Neurosurg

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Background Epidural hematoma constitutes a common condition in neuro-traumatology. If its acute form is well known, the chronic one remains less described. Objective This study aimed to evaluate the epidemiology, clinical presentations, management, and outcomes of chronic epidural hematoma. Methodology Systematic searches of PubMed, Google Scholar, and ScienceDirect were performed from a database searching for all studies reporting chronic epidural hematoma. Pooled statistics were calculated using measures of central tendency and spread. The rank correlation test and the regression test, using the standard error of the observed outcomes as predictor, are used to check for funnel plot asymmetry. Results A total of 3009 studies were identified, of which 95 were included with 359 patients. Chronic epidural hematoma (CEDH) was more common at the intracranial level than spinal level (91.9% vs 8.1%). The average age of onset was 37.2 ± 4.83 years. The common cause found was trauma (n = 279; 77.72%) with 271 (97.1%) cases for the head and 8 (2.9%) cases for the spine. The mean delay between the trauma and the first symptoms was 13.32 ± 1.73 days in intracranial level and 16.38 ± 2.49 days in spinal level. CT scan constituted the main diagnosis tool. The lesion was predominantly located in the temporal region at the intracranial level and lumbar region at the spinal level. Craniotomy and laminectomy constituted the most reported treatment option, respectively, at the intracranial and spinal level. The outcome was commonly uneventful. Correlation and regression tests for publication bias assessment show no significant funnel plot asymmetry with high p value (p = 0.8458 and p = 0.9596, respectively). Conclusion CEDH was commonly related to trauma. Its treatment was mostly surgical at both sites.

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Section: Introductionmentioning

confidence: 99%

Chronic epidural hematoma: a systematic review and meta-analysis

Agada¹,

Bankole²,

Dossou³

et al. 2023

Egypt J Neurosurg

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Benign extradural haemorrhage: scope of conservative trial

Arif,

Kareim,

Fayaz

et al. 2024

Egypt J Neurosurg

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Background Epidural hematomas have been treated with urgent surgical evacuation to prevent catastrophic neurological sequelae and death. Brain Trauma Foundation recommends EDH volume greater than 30 cm3 and warrants surgical evacuation irrespective of GCS. However, due to increase in number of patients undergoing brain CTs following head injuries, more patients have been detected with EDH causing minimal symptoms. Aims and objectives To study factors influencing patients being treated conservatively for head injury with supratentorial epidural hematomas. Material and methods Our study is a retrospective analysis of supratentorial epidural hematoma treated conservatively from august 2018 to July 2020 at Sher-i-Kashmir institute of medical sciences, Srinagar, Jammu and Kashmir. Results A total of 19 patients with EDH were treated conservatively and fulfilled the inclusion criteria.(GCS of 13–15 with no neurological deficit, mild signs of elevated ICP, EDH thickness < 1.5 cm on CT, EDH volume on CT < 30 ml, midline shift on CT less than or equal to 5 mm with no significant intradural pathology)Age ranged from 2 months to 70 years (average 27.15 yrs)males (89.47%) predominated females (10.53%). Motor vehicular accidents were the most common mode of injury (42.1%). EDH was localised 13 times on right side, 5 times on left side and bilateral in one, supratentorially. A midline shift of 5 mm was found in 3 of 19 patients; GCS was > 13 on admission. 8 patients were hospitalised for a week, whilst 2 patients stayed in the hospital for 20 and 25 days, respectively, due to problems not related to EDH. One patient in whom conservative treatment had to be changed to surgical evacuation after 6 days of observation because of worsening headache, impaired alertness repeated imaging showed slight increase in EDH. Conclusions EDH can be managed conservatively in carefully selected patients of minor head injury with radiological surveillance and close neurological monitoring. Patients with GCS on admission more than 13, midline shift of less than 5 mm, location and volume of EDH less than 30 ml. Thus, leading to optimal utilisation of hospital resources. So, we conclude that even a dreaded entity like extradural haemorrhage can be managed conservatively in selected cases with strict clinical and radiological surveillance. We have called them ‘’Benign extradural haemorrhages’’.

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Chronic epidural hematoma presenting with diplopia

Cited by 2 publications

References 18 publications

Chronic epidural hematoma: a systematic review and meta-analysis

Chronic epidural hematoma: a systematic review and meta-analysis

Benign extradural haemorrhage: scope of conservative trial

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