Possible Mechanisms for Rapid Spontaneous Resolution of Acute Epidural Hematomas

Abstract

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. Mögliche Wege der raschen spontanen Resorption von akuten epiduralen Hämatomen. Fallbericht und LiteraturübersichtZusammenfassung Hintergrund: Akute traumatische, epidurale Hämatome sind häufig eine lebensbedrohliche Erkrankung. Sie erfordern eine rasche neurochirurgische Behandlung durch Hämatomausräumung, da sich der klinische Zustand des Patienten sonst in kurzer Zeit verschlechtern und die Raumwirkung des Hämatoms auf das Gehirn zum Tode führen kann. Nur kleine epidurale Hämatome, die sich klinisch asymptomatisch darstellen, können konservativ erfolgreich behandelt werden. Eine engmaschige Überwachung der Patienten ist jedoch erforderlich. Fallbeschreibung: Wir berichten über einen Patienten mit einem ausgedehnten traumatischen epiduralen Häma-tom in der hinteren Schädelgrube, das sich innerhalb einer Stunde spontan resorbierte. Schlussfolgerungen: Es werden mögliche Resorptionsmechanismen beschrieben und die vorhandene Literatur zur konservativen Behandlung akuter epiduraler Hämatome besprochen. Die vorliegende Arbeit befasst sich erstmals mit der spontanen Resorption eines akuten traumatischen epiduralen Hämatoms innerhalb 1 Stunde. Schlüsselwörter: Akutes epidurales Hämatom · Spontane Resorption · Intrakranielle Verletzung · Konservative Behandlung von epiduralen Hämatomen

Simultaneous multiple extradural hematomas

“…The angioblasts form sinusoids that gradually connect with the marginal dural vessels, so blood and blood products can return to the systemic circulation via the permeable membrane of these sinusoids. 23,24 However, such hematoma resolution is reported as longer than three weeks. 23 Medical treatment, repeated CT scan and close neurological follow-up are essential in the conservative management.…”

Rapid resolution of acute epidural hematoma: case report and review of the literature

“…[6][7][8] Medical treatment, repeated CT scan and close neurological follow-up are essential in the conservative management. [2][3][4][5][6][9][10][11]13] In the present case, the EDH was not large enough to warrant absolute surgical intervention. Surprisingly, a very rapid spontaneous resolution of the hematoma was observed and this can be considered an extremely rare situation.…”

“…The angioblasts form sinusoids that gradually connect with the marginal dural vessels, so blood and blood products can return to the systemic circulation via the permeable membrane of these sinusoids. [1,5,6,[11][12][13] However, such hematoma resolution is reported as longer than three weeks. [6][7][8] Medical treatment, repeated CT scan and close neurological follow-up are essential in the conservative management.…”

Spontaneous Decompression of Extradural Hematoma Through Skull Fracture

“…5,9,14,[17][18][19] The mechanism behind chronic resolution of EDH is that there is formation of fibrovascular neomembrane and granulation tissue, acting as a semipermeable membrane like absorbing structure through which there is transfer of the clot into diploic bone or extracranial space through the fractures. 2,3,6,[8][9][10]14,20,21 In acute, the reduction in size of the EDH occurs though overlying skull fracture causing transfer of collection to the subgaleal space. 8,14,18,22 It is further facilitated by increase in intracranial pressure that creates a pressure gradient and forcing out the clot from epidural space to the subgaleal space through the fracture.…”

“…It has been estimated that acute epidural hematoma (EDH) accounts for 1.5% of patients treated for traumatic brain injury and the lesion can be potentially fatal, and urgent surgical intervention is recommended. [1][2][3][4][5][6][7] However, it has been increasingly recognized that there is a subgroup of patients, where the EDH disappeared rapidly without surgical evacuation. 1,4,5,[8][9][10][11][12][13] In present article, we report a case of an elderly gentleman whose follow-up computed tomography (CT) scan showed reduction in the size of acute EDH and review the relevant literature.…”