Indian Journal of Neurotrauma 2015; 12(01): 023-027
DOI: 10.1055/s-0035-1554994
Original Article

Simultaneous Multiple Extradural Hematomas

Parag Agarwal
1   Department of Neurosurgery, Nilratan Sircar Medical College and Hospital, Sealdah, Kolkata, West Bengal, India
,
Kaushik Roy
1   Department of Neurosurgery, Nilratan Sircar Medical College and Hospital, Sealdah, Kolkata, West Bengal, India
,
Parimal Tripathy
1   Department of Neurosurgery, Nilratan Sircar Medical College and Hospital, Sealdah, Kolkata, West Bengal, India
› Author Affiliations

Abstract

Objective Simultaneous multiple epidural hematomas (EDHs) are very rare and are associated with high mortality. The purpose of this study is to identify the clinical features, varying mechanisms that may be responsible for production of these hematomas, location of hematomas, and outcome of simultaneous multiple EDHs.

Methods Our study consisted of 528 patients who were admitted in our emergency department with diagnosis of traumatic brain injury (TBI) over a period of 14 months from September 2012 to October 2013 and retrospective analysis of all cases with EDH, particularly those with simultaneous multiple EDHs was done. All the patients were carefully examined clinically, Glasgow Coma Scale (GCS) was noted, plain computed tomographic scan (CT scan) was done and managed accordingly.

Results We came across six cases of multiple EDHs which accounted to 1.13% of all TBI. All of the cases except one were diagnosed within the first 6 hours. The GCS was used for neurological evaluations on admission and during hospital stay. A CT scan was done in all cases. Five patients underwent surgical intervention and one was managed conservatively. Two patients expired due to pre- and postoperative complications.

Conclusion EDHs are serious manifestation of TBI, of which multiple EDHs are even worse. These are life-threatening conditions. Early recognition and treatment can save a precious life. Widespread use of CT scan leads to early diagnosis before deterioration of the neurological status and affects the outcome of surgery.



Publication History

Received: 17 September 2014

Accepted: 04 December 2014

Publication Date:
30 June 2015 (online)

© 2015. Thieme. All rights reserved.

Neurotrauma Society of India

 
  • References

  • 1 Coronado VG, Xu L, Basavaraju SV. , et al. Surveillance for traumatic brain injury-related deaths—United States, 1997—2007. MMWR Surveill Summ 2011; 60: 1-32
  • 2 Maas AI, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol 2008; 7: 728-741
  • 3 Pardini Jamie, Bailes EJulian, In: Richard Winn. , ed. Mild Traumatic Brain Injury in Adult and Concussion in Sports, Youmans Neurological Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2011: 3366
  • 4 Roy GC. Fracture of skull, extensive extravasation of blood on dura mater, producing compression of brain, trephining, partial relief of symptoms, death. Lancet 1884; 2: 319
  • 5 Sharma V, Newton G. Bilateral extradural hematoma. Neurol India 1990; 38: 455-459
  • 6 CDC QuickStats: injury and traumatic brain injury-related death rates by age-United States. Morb Mortal Wkly Rep 2006; 59: 303
  • 7 Reilly P. The impact of neurotrauma on society: an international perspective In: Neurotrauma: New Insights into Pathology and Treatment. Amsterdam, The Netherlands: Academic Press; 2007: 5-7
  • 8 Rochat P, Johannesen HH, Poulsgard L, Bogeskov L. Sequentially evolved bilateral epidural haematomas. Clin Neurol Neurosurg 2002; 105: 39-41
  • 9 Richard Winn H, Blumbergs C Peter. In: Richard Winn H. Neuropathology of Traumatic Brain Injury, Youmans Neurological Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2011: 3294
  • 10 Dharker SR, Bhargava N. Bilateral epidural haematoma. Acta Neurochir (Wien) 1991; 110: 29-32
  • 11 Frank E, Berger TS, Jew JM. Bilateral epidural hematoma. Surg Neurol 1982; 17: 218-222
  • 12 Gurdjian ES. Recent advances in the study of the mechanism of impact injury of the head. A summary. Clin Neural 1972; 11: 1-42
  • 13 Hooper R. Observations on extradural hemorrhage. Br J Surg 1959; 47: 71-87
  • 14 McCormick WF, Pathology of closed head injury In: Wilkins RH, Rangachary SS. , eds. Neurosurgery. 2nd ed. New York, NY: McGraw Hill Inc; 1996: 2643
  • 15 Huda MF, Mohanty S, Sharma V, Tiwari Y, Choudhary A, Singh VP. Double extradural hematoma: an analysis of 46 cases. Neurol India 2004; 52: 450-452
  • 16 Gorgulu A, Cobanoglu S, Armagan S, Karabagli H, Tevruz M. Bilateral epidural hematoma. Neurosurg Rev 2000; 23: 30-33
  • 17 Idei M, Shima T, Nishida M. , et al. Symmetrical bilateral epidural hematoma after head injury in the mid parietooccipital region: case report. No Shinkei Geka 2004; 32: 379-382
  • 18 Rasmussen GL, Holme S. Bilateral epidural hematomas. Ugeskr Laeger 1991; 154: 203-204
  • 19 Chris Zacko J, Harris Leo, Surgical management of traumatic brain injury In: Richard Winn H. , ed. Youmans Neurological surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2011: 3427
  • 20 Barlow P, Kohi YM. Acute simultaneous bilateral extra- dural hematoma. Surg Neurol 1985; 23: 411-413
  • 21 Weaver D, Pobereskin L, Jane JA. Spontaneous resolution of epidural hematomas. Report of two cases. J Neurosurg 1981; 54: 248-251
  • 22 Aoki N. Rapid resolution of acute epidural hematoma. Report of two cases. J Neurosurg 1988; 68: 149-151
  • 23 Kuroiwa T, Tanabe H, Takatsuka H. , et al. Rapid spontaneous resolution of acute extradural and subdural hematomas. Case report. J Neurosurg 1993; 78: 126-128
  • 24 Wagner A, Freudenstein D, Friese S, Duffner F. Possible mechanisms for rapid spontaneous resolution of acute epidural hematomas. Klin Neuroradiol 2002; 12: 45-50
  • 25 Illingworth R, Shawdont H. Conservative management of intracranial extradural haematoma presenting late. J Neurol Neurosurg Psychiatr 1983; 46: 558-560