
Risk factors for post-traumatic massive cerebral infarction secondary to space-occupying epidural hematoma.
Wang Wen-hao,Hu Lian-shui,Lin Hong,Li Jun,Luo Fei,Huang Wei,Lin Jun-ming,Cai Gen-ping,Liu Chang-chun
Journal of neurotrauma
Post-traumatic massive cerebral infarction (MCI) is a fatal complication of concurrent epidural hematoma (EDH) and brain herniation that commonly requires an aggressive decompressive craniectomy. The risk factors and surgical indications of MCI have not been fully elucidated. In this retrospective study, post-traumatic MCI was diagnosed in 32 of 176 patients. The performance of a decompressive craniectomy simultaneously with the initial hematoma-evacuation surgery improved their functional outcomes, compared with delayed surgery (on the 6-month Extended Glasgow Outcome Scale, 5.6±1.5 vs. 3.4±0.6; p<0.001). Significantly increased risks for MCI were observed in patients with an EDH at a transtemporal location (adjusted odds ratio [OR], 16.48; p=0.003), an EDH larger than 100 mL in volume (OR, 7.04; p=0.001), preoperative shock for longer than 30 min (OR, 13.78; p=0.002), bilateral mydriasis (OR, 7.08; p=0.004), preoperative brain herniation for longer than 90 min (OR, 6.41; p<0.001), and a Glasgow Coma Score of 3-5 points (OR, 2.86; p<0.053). Multi-variate logistic regression analysis revealed no significant association between post-traumatic MCI and age, gender, mid-line shift, Rotterdam computed tomography score, intraoperative hypotension, or serum concentrations of sodium or glucose. Incidence of post-traumatic MCI increased from 16.4% in those having any two of the six risk factors to 47.7% in those having any three or more of the six risk factors (p<0.001). Patients with concurrent EDH and brain herniation exhibited an increased risk for post-traumatic MCI with the accumulation of several critical clinical factors. Early decompressive craniectomy based on accurate risk estimation is recommended in efforts to improve patient functional outcomes.
10.1089/neu.2013.3142
Development of a delayed acute epidural hematoma following contralateral epidural hematoma evacuation: case report and review of literature.
Gregori Fabrizio,Santoro Giorgio,Mancarella Cristina,Piccirilli Manolo,Domenicucci Maurizio
Acta neurologica Belgica
The formation of a post-traumatic delayed epidural hematoma (DEDH) is a rare but well-described complication in the literature. It is defined as an extradural bleeding not evident at the first computed tomography (CT) scan performed after trauma, but evidenced by further radiological evaluations. The most supported hypothesis about the mechanism responsible for the formation of a DEDH concerns above all the loss of a tamponade effect given by the reduction of intracranial pressure with medical or surgical treatment. A 30-year-old man was admitted to the emergency department with an epidural hematoma (EDH) associated with a linear calvarial bitemporal coronal fracture. A few hours after the surgical procedure for hematoma evacuation, the patient developed a DEDH contralateral to the site of surgical procedure. The literature review identified other 27 analogue cases. The presence of a calvarial fracture contralateral to the site of a craniotomy and the intraoperative brain swelling during EDH removal are suspicious for the development of DEDH. A CT scan has to be urgently performed in this situation. The timing of postoperative radiological examinations after EDH removal has to consider possible complications and has to be balanced on the basis of patient's clinical condition and neuroradiological data, such as skull fractures or intraoperative anomalies. The development of a DEDH after the surgical removal of an EDH is a rare event, characterized by a high mortality rate. DEDH develops preferentially on the contralateral side and with a concomitant skull fracture.
10.1007/s13760-018-1049-y