Is the presence of a linear fracture a predictor of delayed posterior fossa epidural hematoma?

Kircelli, Atilla; Özel, Ömer; Can, Halil; Sarı, Ramazan; Cansever, Tufan; Elmacı, İlhan

doi:10.5505/tjtes.2015.52563

Cited by 13 publications

(12 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…They occur in a wider variety of locations (Figure 2 ), in part because these are often due to venous rather than arterial hemorrhages ( 13 ). Fractures in the occipital and suboccipital regions are particularly concerning because of the risk of a posterior fossa hematoma, which rapidly causes brainstem compression as well as hydrocephalus by fourth ventricular and aqueduct obstruction ( 48 – 50 ). Subdural hematomas (Figure 3 ) are associated with more severe injuries to the parenchyma, cortical veins, and venous sinuses ( 51 – 53 ).…”

Section: Cranial and Spinal Anatomical Differences And Implications Fmentioning

confidence: 99%

Anatomical and Physiological Differences between Children and Adults Relevant to Traumatic Brain Injury and the Implications for Clinical Assessment and Care

Figaji

2017

Front. Neurol.

140

View full text Add to dashboard Cite

General and central nervous system anatomy and physiology in children is different to that of adults and this is relevant to traumatic brain injury (TBI) and spinal cord injury. The controversies and uncertainties in adult neurotrauma are magnified by these differences, the lack of normative data for children, the scarcity of pediatric studies, and inappropriate generalization from adult studies. Cerebral metabolism develops rapidly in the early years, driven by cortical development, synaptogenesis, and rapid myelination, followed by equally dramatic changes in baseline and stimulated cerebral blood flow. Therefore, adult values for cerebral hemodynamics do not apply to children, and children cannot be easily approached as a homogenous group, especially given the marked changes between birth and age 8. Their cranial and spinal anatomy undergoes many changes, from the presence and disappearance of the fontanels, the presence and closure of cranial sutures, the thickness and pliability of the cranium, anatomy of the vertebra, and the maturity of the cervical ligaments and muscles. Moreover, their systemic anatomy changes over time. The head is relatively large in young children, the airway is easily compromised, the chest is poorly protected, the abdominal organs are large. Physiology changes—blood volume is small by comparison, hypothermia develops easily, intracranial pressure (ICP) is lower, and blood pressure normograms are considerably different at different ages, with potentially important implications for cerebral perfusion pressure (CPP) thresholds. Mechanisms and pathologies also differ—diffuse injuries are common in accidental injury, and growing fractures, non-accidental injury and spinal cord injury without radiographic abnormality are unique to the pediatric population. Despite these clear differences and the vulnerability of children, the amount of pediatric-specific data in TBI is surprisingly weak. There are no robust guidelines for even basics aspects of care in children, such as ICP and CPP management. This is particularly alarming given that TBI is a leading cause of death in children. To address this, there is an urgent need for pediatric-specific clinical research. If this goal is to be achieved, any clinician or researcher interested in pediatric neurotrauma must be familiar with its unique pathophysiological characteristics.

show abstract

Section: Cranial and Spinal Anatomical Differences And Implications Fmentioning

confidence: 99%

Anatomical and Physiological Differences between Children and Adults Relevant to Traumatic Brain Injury and the Implications for Clinical Assessment and Care

Figaji

2017

Front. Neurol.

140

View full text Add to dashboard Cite

show abstract

“…Diagnosis and cure of EDH of the posterior cranial fossa were possible following the first case of successful surgery, reported by Coleman and Thompson in 1941. [ 4 ] Surgery remains the gold standard for the treatment of TSIEDH. This may be in the form of suboccipital craniectomy or craniotomy depending on the size of the hematoma.…”

Section: Discussionmentioning

confidence: 99%

“…Following the alleviation of the tamponade effect on intracranial volume, EDH constitutes a threat to life. [ 4 ] Based on data from Bogdan Asanin, EDH of the posterior cranial fossa accounted for 0.11% of craniocerebral injuries or 7.9% of EDH recorded. [ 3 ] EDH comprises the most frequent traumatic space-occupying lesion of the posterior fossa.…”

Section: Introductionmentioning

confidence: 99%

Traumatic supra- and infra-tentorial extradural hematoma: Case series and literature review

2018

View full text Add to dashboard Cite

Traumatic supra- and infra-tentorial extradural hematoma (TSIEDH) is a rare lesion constituting <2% of all extradural hematomas. There are only a few published articles about TSIEDH. This study included three patients with TSIEDH who were treated and operated at Dr. Soetomo General Hospital, Surabaya, Indonesia, from August 2015 to July 2016. Two patients sustained injuries in traffic accidents and one patient was injured by fall. The male to female ratio was 1:2. Glasgow Coma Scale (GCS) score ≤8 was present in one and GCS score of 9–12 was present in two patients. The brain computed tomography scan verified linear fracture of occipital bone in one and linear fracture of occipital bone with lambdoid suture separation in two patients. Early diagnosis and early surgical intervention of TSIEDH are imperative because the deterioration of TSIEDH is sudden and quick. We presented our experience in treating patients with TSIEDH in Dr. Soetomo General Hospital, Surabaya, Indonesia.

show abstract

“…Rarely reported in mild head traumas [25], DEDH is commonly associated with skull fractures [20]. DEDH development in the infratentorial compartment is tenfold higher in patients with fracture line in the posterior fossa than in patients with supratentorial fractures [26]. Rapid deterioration of an injured patient, especially if DEDH is formed in the posterior fossa, could be lethal despite urgent CT brain scan and prompt operation [25].…”

Section: Disscusionmentioning

confidence: 99%

A combination of acute and delayed contralateral epidural hematoma

Kostić¹,

Veselinović

Nikolov³

et al. 2018

Srp Arh Celok Lek

View full text Add to dashboard Cite

Introduction An acute bilateral extradural hematoma is an uncommon presentation of a traumatic head injury; however, it leads to higher mortality rate than an acute unilateral hematoma. A delayed epidural hematoma (DEDH) is a hematoma not present on the initial computed tomography (CT) scan but is found on a subsequent CT scan. While reviewing the literature, we could not find recently published papers considering supratentorial DEDH after primary operated contralateral epidural hematoma. Case outline A comatose 14-year-old male patient with Glasgow Coma Scale score of 4 and the right mydriatic pupil on the side of the blunt trauma to the head was admitted to the intensive care unit after he had survived a traffic accident. The initial brain CT scan showed an acute temporoparietal epidural hematoma on the right side of the cranium, with impressive midline shift and bilateral linear skull fracture. Surgery was performed and an intracranial pressure (ICP) monitor was implanted, which showed increased values of ICP. A control brain CT scan performed within 24 hours showed a new contralateral occipitoparietal epidural hematoma. Another operation was performed. A second, control CT brain scan showed favorable findings. The patient was transferred after 25 days to the rehabilitation center, with the disability rating score of 11, which was reduced to 1 after three months. Conclusion A contralateral DEDH is a life-threatening neurosurgical emergency case which can occur during the first 24 hours after decompressive craniectomy. Control CT scans should be performed one day after the operation in order to verify and treat DEDH timely. A high degree of vigilance and ICP monitoring is recommended in these cases, especially after surgical decompression.

show abstract

Is the presence of a linear fracture a predictor of delayed posterior fossa epidural hematoma?

Cited by 13 publications

References 19 publications

Anatomical and Physiological Differences between Children and Adults Relevant to Traumatic Brain Injury and the Implications for Clinical Assessment and Care

Anatomical and Physiological Differences between Children and Adults Relevant to Traumatic Brain Injury and the Implications for Clinical Assessment and Care

Traumatic supra- and infra-tentorial extradural hematoma: Case series and literature review

A combination of acute and delayed contralateral epidural hematoma

Contact Info

Product

Resources

About