Successful conservative management of large vertex epidural hematoma

Champeaux, Charles; Lainé, Gaëtan; Gimbert, Édouard; Jecko, Vincent

doi:10.1016/j.neuchi.2019.05.002

Cited by 5 publications

(3 citation statements)

References 5 publications

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“…A skull fracture is found in most of the epidural bleeding, and the diploic vein represents one of the hemorrhagic sources. Because of the lower pressure, epidural bleeding caused by diploic vein rupture extended more gradually than those induced by arterial sources (such as the middle meningeal artery) [10] . This, alongside the fact that the duramater is not firmly attached to the skull in children, may explain the association between delayed progressive epidural bleeding and skull fracture.…”

Section: Discussionmentioning

confidence: 99%

Delayed progressive intracranial bleeding in pediatric acute epidural hemorrhage treated expectantly

Siahaan¹,

Susanto²,

Luis³

et al. 2023

International Journal of Surgery Case Reports

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Section: Discussionmentioning

confidence: 99%

Delayed progressive intracranial bleeding in pediatric acute epidural hemorrhage treated expectantly

Siahaan¹,

Susanto²,

Luis³

et al. 2023

International Journal of Surgery Case Reports

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“…Conservative treatment was preferred in some cases even if the patients were neurologically compromised or there was significant mass effect on CT scans. [ 7 , 12 , 25 , 26 ] In addition to surgical difficulties including high mortality risk, unpredictable nature of this entity may complicate to make a decision about surgical need. [ 18 ] In case of nonsurgical decision, close follow-up is essential and it should be kept in mind that neurological worsening may be quick and irreversible.…”

Section: Discussionmentioning

confidence: 99%

A Series of Posttraumatik Midline Epidural Hematoma and Review of the Literature

Güçlü¹

2020

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Supratentorial midline epidural hematoma is rare but challenging in diagnosis and management. Indication for surgery can arise even following hospital admission. Being familiar to the presentation and watching out for direct and indirect signs on axial computed tomography (CT) such as suture diastasis or fracture traversing midline are essential to plan multi-planar CT enabling exact diagnosis including form and mass effect of hematoma. METHODS: Nine patients with midline epidural hematoma including two pediatric patients underwent surgery between 2013 and 2018. Pre-operative and post-operative patient status, radiological features, and surgical technique were analyzed. RESULTS: Four patients had deteriorating consciousness levels and two patients had paraparesis. All had fractures traversing midline and epidural hematomas with significant mass effect. They were operated through separated craniotomies around the midline and midline bone strip was used for dural tenting and as support for natural closure of bone flaps. No post-operative complications were developed. All patients were discharged with Glasgow Outcome Score of 5. CONCLUSION: Because of the rarity of the lesion and small number of patients, definitive conclusions may be misleading but we think that, in experienced hands, midline epidural hematomas can safely be operated on and, preservation of midline bone strip provides easier bleeding control.

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“…The most common symptom is headache. In addition, there may be symptoms such as vomiting, seizures, numbness or loss of strength in the extremities, and cranial nerve paralysis (2,8).…”

Section: Case Presentationmentioning

confidence: 99%

Conservative Management of Large Vertex Extradural Hematoma: A Case Report

TUNÇ,

ÇAĞIL,

GUNERHAN

et al. 2023

Medical Research Reports

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Vertex extradural hematomas may be missed when axial section brain computed tomographic scans are used alone for diagnosis. Conservative treatment may be preferred in such patients when actualized the essential conditions. A 24-year-old mentally retarded male patient was admitted to the emergency department with a history of falling from the same level and head trauma. Neurological examination and axial cross-sectional brain computed tomography performed in the emergency room were evaluated as normal, and the patient was discharged. Vertex extradural hematoma adjacent to the bone fracture was diagnosed with axial, coronal and sagittal reconstructed brain computerized tomography sections of the patient who came back with headache complaint 2 days later. Despite the difficulties in neurological examination due to mental retardation, surgical treatment was not planned with very close neurological examination. The patient was followed up in the neurosurgery intensive care unit for 2 days and in the neurosurgery service for 7 days. He was discharged because there was no abnormality in his neurological follow-ups and no increase in hematoma size. In the first outpatient follow-up, one month later, the hematoma was completely resorbed. The patient was treated conservatively with close conscious and neurological examination follow-up. In order not to miss vertex extradural hematomas in the brain computed tomography performed in patients presenting to the emergency department with head trauma, coronal and sagittal sections should be reconstructed in addition to axial sections. Conservative treatment can be preferred if vertex extradural hematomas are neurological examined closely, no motor deficits and there is no increase in hematoma size in control imaging.

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Successful conservative management of large vertex epidural hematoma

Cited by 5 publications

References 5 publications

Delayed progressive intracranial bleeding in pediatric acute epidural hemorrhage treated expectantly

Delayed progressive intracranial bleeding in pediatric acute epidural hemorrhage treated expectantly

A Series of Posttraumatik Midline Epidural Hematoma and Review of the Literature

Conservative Management of Large Vertex Extradural Hematoma: A Case Report

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