Extradural hæmorrhage

Packing to tamponade severe intracranial hemorrhage in pediatric patients

The medical records of all children in whom packing was used to control severe intracranial hemorrhage were reviewed. Eight children, with ages ranging from newborn to 4 years, met the inclusion criteria and all survived. Five were victims of severe closed head trauma, 2 had received penetrating cranial injuries, and 1 developed severe bleeding while undergoing surgery for a malignant tumor in the posterior fossa. Blood loss at the time of removal of the packing was minimal in 7 patients and was surgically controllable in the other. Packing is a simple, efficient, and safe maneuver which can very often halt intracranial bleeding that is considered to be otherwise uncontrollable, and can thereby limit the consequences of prolonged or repeated periods of hypotension and possible exsanguination.

Posterior fossa extradural hematoma: our experience and review of the literature

BACKGROUND

Posterior fossa EDH is an uncommon entity, accounting for only 4% to 12.9% of all EDHs It has a characteristic clinical presentation, which if detected can be life-saving.

METHODS

We sought to study the demographic features of patients with PFEDH and assess the clinical and radiologic predictors of the outcomes of as well as evaluate the various treatment modalities for this disease. We carried out a retrospective analysis of the cases of 61 patients with PFEDH who were admitted to the National Institute of Mental Health and Neurosciences (Bangalore, India) from 1991 through 2002. We analyzed various parameters and applied Fisher's exact test for statistical analysis.

RESULTS

Mostly male individuals were affected with PFEDH. Their GCS score at admission and the presence of hydrocephalus as detected by CT scan determined the outcome of the patients. The children had better outcomes than did the adults. Patients with a good GCS score could be managed conservatively.

CONCLUSIONS

Posterior fossa EDH is rare. The PF is an unfavorable location of a hematoma. Good GCS scores have a favorable prognosis. Children have better outcomes than do adults, and the presence of hydrocephalus on CT scan is an ominous sign.

[Extradural hematoma of the posterior fossa. Report of 7 cases]

Hematomas of the posterior fossa are an uncommon complication of head injury. Almost invariably they occur after trauma of the occiput, and are associated with skull fracture. Their diagnosis and management have been greatly improved by CT scanning. In the present series, the majority of patients had acute evolution indicating the potential hazard of conservative treatment. Our results (29% mortality) are similar to those previously reported in other series.

[Extradural hematoma: comparative radiological study between comatose and non-comatose patients]

A series of 129 patients harbouring extradural hematomas was analysed considering the neurological state immediately before operation as the most consistent variable. Seventy eight patients were considered to be comatose (Group I) and 51 were noncomatose. Among the comatose group, 30 were investigated with computerized tomography (23.3% mortality, 50% good results), 31 were submitted to angiography (48.3% mortality, 38.7% good results), and 17 were operated based on the neurological examination and skull radiography (47% mortality, 35.2% good results). The presence or absence of skull fracture and the density of hematoma did not change the final outcome. Associated intracranial lesions increased the mortality and lowered the good results in both groups. Frontal hematomas (10 cases) in the comatose group were associated with high mortality (52.6%) due to bad neurological state (Glasgow 3-5) and to isolated or multiple intracranial associated lesions (6 patients).

Clivus epidural hematoma. Case report

A rare case of epidural hematoma of the clivus is reported in an 11-year-old girl involved in a traffic accident which caused a severe hyperextension injury. Only one similar case has been reported in the literature. The mechanism for the formation of the hematoma of this region is discussed.

Extradural haematoma of the posterior fossa. Twelve years experiences with CT-scan

18 cases of an extradural haematoma of the posterior fossa (EDHPF) are presented and the clinical and radiological findings are demonstrated. The onset of symptoms was acute in 10 patients and subacute in the other 8 patients. The overall mortality was 22%, but only acute course patients died (40%). All subacute cases survived. The most important factors influencing mortality were the level of consciousness immediately before the operation and the presence of hydrocephalus prior to surgery. Other coexisting intracranial lesions had no influence on mortality but on the quality of survival. Compared with the literature there is a certain decrease in mortality in the subacute course patients since the introduction of computed tomography.

Extradural haematoma of the posterior fossa: a report of eight cases and a review of the literature

The authors review the literature and present 8 cases of extradural haematoma of the posterior fossa operated from 1979 to 1985 at the Neurosurgical Clinic of the University of Pavia. Emphasis is placed on the importance of an early diagnosis of the symptoms which are often ignored due to the absence of specific clinical signs. The authors recognize a substantial improvement in results because of the recent introduction of CT scanning facilities which permit an early and precise diagnosis of this traumatic pathology.

Double lucid interval in patients with extradural hematoma of the posterior fossa

✓ The classic clinical sequence in posterior fossa extradural hematoma is head injury, lucid interval, deterioration; the deterioration is usually terminated by death or surgical intervention. This report emphasizes a syndrome characterized by a double lucid interval in which the phase of deterioration terminates spontaneously with improvement. This is actually only a second lucid interval and can lead surgeons into a false sense of security since it is followed by deterioration, as the clot continues to enlarge. Four such cases are described in detail. The characteristics of the initial phase of deterioration are described and contrasted with those of the deterioration following the lucid interval in the classic supratentorial extradural hematoma.

Disturbances of oculomotor function accompanying extradural haemorrhage

Images