Spontaneous Posterior Fossa Extradural Hematoma – A Rare Complication following Cardiac Surgery

Abstract

Posterior fossa extradural hematoma (PFEDH) is an infrequent condition. Though numerous neuropathological sequelae of cardiopulmonary bypass have been described, to the best of the authors’ knowledge, PFEDH after cardiac surgery has not been reported in the English literature. We report a 4-year-old boy with tricuspid atresia, who underwent cardiac surgery under cardiopulmonary bypass. On the 2nd postoperative day, his neurological condition deteriorated, and a CT scan of the head revealed a large PFEDH with mass effect and hydrocephalus. He underwent a midline suboccipital craniectomy and evacuation of PFEDH. There was diffuse bleeding from the dura; however, no specific site of bleeding was identified. The child started following commands on the 1st postoperative day, had an uneventful recovery and was discharged on the 10th postoperative day. On follow-up, 1 year after the surgery, he was doing well.

Extradural hematoma following double valve replacement under cardiopulmonary bypass: A rare complication

“…[8] Spontaneous EDH following full heparinization during CPB has been reported in the medical literature: In one of those reports, cyanotic congenital heart disease causing coagulation abnormalities was considered as the cause of EDH. [1] Anegawa, et al, reported bifrontal EDH with mass effect in a 12-year-old female following surgery for subaortic stenosis. [3] The causes of space occupying hematoma following CPB could be either full heparinization during surgery and/or associated hypotension during the period of CPB.…”

“…A few reports describe EDH following cardiac surgery on CPB. [1][2][3] We describe our experience of EDH following double valve replacement in an adolescent boy.…”

Warfarin Induced Spontaneous Posterior Fossa Extradural Hematoma

“…Brain CT was done, that showed posterior fossa EDH (PFEDH), which is very unusual and rare finding on imaging to occur spontaneously without any history of trauma. According to our best of knowledge previously only 18 cases of spontaneous PFEDH were reported till date since 1951 1 . In past, such case has been reported after cardiac surgery for tricuspid area in 4 years male child 2 .…”

Posterior fossa acute extradural hematoma in children: Review and management guidelines

“…[ 8 ] Children have the dura and venous sinuses as opposed to the bones, and bleeding from the venous sinus leads to progressive stripping of the dura from the bone and an expanding PFEDH. Rarely PFEDH is seen in association with other bleeding diathesis,[ 9 10 11 12 ] systemic illness,[ 13 ] after cardiac surgery,[ 14 ] and malignancies such as angiosarcoma,[ 15 ] presenting either spontaneously or after a fall.…”