Serial CT Findings of a Rapidly Calcified Epidural Hematoma in a Young Adult: A Case Report

We report serial computed tomography (CT) findings in a rare case of a rapidly calcified epidural hematoma. A 21‐year‐old female patient was admitted to our hospital after being involved in a motor vehicle accident. An initial cranial CT revealed a right frontal bone fracture. She complained of right frontal headache, but showed no neurological deficit or tendency for bleeding. Therefore, she was treated conservatively without surgical intervention. Follow‐up CT revealed an ossified epidural hematoma (EDH) 17 days after the head injury, and the ossification later thickened. However, a decrease in the width of the EDH was observed during the 9 months of follow‐up during which serial CT images were acquired. The EDH resolved 9 months after the initial trauma, but the calcification layer remained thickened.     

Spontaneous Epidural Hematoma from Skull Base Metastasis of Hepatocellular Carcinoma

We report a case of an acute spontaneous epidural hematoma (EDH) due to skull base metastasis in a 46-year-old male patient with hepatocellular carcinoma (HCC). The patient presented with the acute onset of severe headache followed by unconsciousness, and computed tomography showed a large EDH in the right temporal and parietal lobes with midline shift. Emergency evacuation of the EDH was performed, and the hemorrhage was determined to be secondary to skull base metastasis of HCC.     

Epidural Hematoma after Minor Trauma on Patient with Biparietal Osteodystrophy

Thinning of parietal bone bilaterally is extremely rare but well known phenomenon. Approximate prevalence is 0.4-0.5% according to radiological scans, case reports and anthropologic researches. Even though biparietal osteodystrophy occurs mostly in over 60-year-old women, it shows no special association with race or geographical area tendency. Current definition was changed by understanding that is a pathological situation, not an anatomical variety or result of growing old in time. Biparietal osteodystrophy may have an unusual presentation and treatment still remains unclear. We aim to present a patient with biparietal osteodystrophy associated with minor head trauma that caused parietal fracture and epidural hematoma underneath.     

Eosinophilic Granuloma Presenting as an Epidural Hematoma and Cyst

Langerhans'' cell histiocytosis (LCH) is a rare immunologic disorder characterized by histiocyte proliferation in multiple organ systems. Eosinophilic granuloma, a benign bone lesion, represents a focal form of LCH. We experienced a case of Langerhans'' cell histiocytosis in a patient who presented with intracranial epidural hematoma and cyst on the midline of the frontal skull. A 10-year-old boy presented with a rapidly growing large scalp mass on the midline frontal area after mild head trauma. The scalp mass was painless and immobile. Plain skull x-ray showed a punched-out bone lesion. Computed tomography and magnetic resonance imaging showed a non-enhancing osteolytic lesion presenting with an epidural hematoma and cyst on the midline of the frontal skull. The lesion of the skull was completely resected and the patient''s recovery was uneventful. The acute presentation of a solitary eosinophilic granuloma of skull with an epidural hematoma has been described in only five cases in the literature and we report the first case of LCH presenting as an intracranial epidural hematoma on frontal area.     

Intracranial Chronic Subdural Hematoma Presenting with Intractable Headache after Cervical Epidural Steroid Injection

Postdural punctural headache (PDPH) following spinal anesthesia is due to intracranial hypotension caused by cerebrospinal fluid (CSF) leakage, and it is occasionally accompanied by an intracranial hematoma. To the best of our knowledge, an intracranial chronic subdural hematoma (CSDH) presenting with an intractable headache after a cervical epidural steroid injection (ESI) has not been reported. A 39-year-old woman without any history of trauma underwent a cervical ESI for a herniated nucleus pulposus at the C5-6 level. One month later, she presented with a severe headache that was not relieved by analgesic medication, which changed in character from being positional to non-positional during the preceding month. Brain magnetic resonance imaging revealed a CSDH along the left convexity. Emergency burr-hole drainage was performed and the headache abated. This report indicates that an intracranial CSDH should be considered a possible complication after ESI. In addition, the event of an intractable and changing PDPH after ESI suggests further evaluation for diagnosis of an intracranial hematoma.     

Chronic Subdural Hematoma after Spontaneous Intracranial Hypotension : A Case Treated with Epidural Blood Patch on C1-2

Spontaneous cerebrospinal fluid (CSF) leak is a recognized cause of spontaneous intracranial hypotension (SIH). Subdural hematoma (SDH) is a serious but rare complication of SIH. An autologous epidural blood patch at the CSF-leak site can effectively relieve SIH. We report a case of bilateral SDH with SIH caused by a CSF leak originating at the C1-2 level. A 55-year-old male complained of orthostatic headache without neurological signs. His symptoms did not respond to conservative treatments including bed rest, hydration and analgesics. Magnetic resonance imaging showed a subdural hematoma in the bilateral fronto-parietal region, and computed tomography (CT) myelography showed a CSF leak originating at the C1-2 level. The patient underwent successful treatment with a CT-guided epidural blood patch at the CSF-leak site after trephination for bilateral SDH.     

急性硬脊膜外血肿的诊治特点

目的探讨急性硬脊膜外血肿的病因、临床诊治特点。方法分析近15年来经手术治疗的38例急性硬脊膜外血肿的病因、临床表现、MRI/DSA影像学及显微手术特点。结果38例病人均行MRI检查,28例直接手术清除血肿;10例行DSA检查,6例先行硬脊膜动静脉瘘(AVF)供血动脉栓塞,再手术清除血肿并切除瘘口,1例患者术前诊断急性硬脊膜外血肿,术后病理证实为脊髓结核急性期。随访2~9年。神经系统恢复到正常情况的13例;有轻度神经系统改变但生活可以自理的19例;需他人帮助者4例;2例因血肿压迫时间长,术后双下肢瘫痪及尿潴留未改善;本组无死亡病例。结论急性硬脊膜外血肿的早期诊断和早期治疗是提高疗效的关键。脊髓MRI检查是诊断急性硬脊膜外血肿的首选方法,清除血肿减轻其对脊髓的压迫是治疗本病的唯一有效方法,大的、高血流量的AVF术前栓塞供血动脉可减少术中出血。     

Clinical Experience and Management of Cervico-Thoracic Epidural Hematoma

Spinal epidural hematoma (SEH) causing acute myelopathy is rare. The usual clinical presentation of a SEH is sudden severe neck or back pain that progresses toward paraparesis or quadriparesis, depending on the level of the lesion. Recent studies have shown that early decompressive surgery is very important for patient''s recovery. We experienced five patients of cervico-thoracic epidural hematomas associated with neurologic deficits that were treated successfully with surgical intervention.     

Spinal Epidural Hematoma after Pain Control Procedure

Spinal epidural hematoma is a rare complication associated with pain control procedures such as facet block, acupuncture, epidural injection, etc. Although it is an uncommon cause of acute myelopathy, and it may require surgical evacuation. We report four patients with epidural hematoma developed after pain control procedures. Two procedures were facet joint blocks and the others were epidural blocks. Pain was the predominant initial symptom in these patients while two patients presented with post-procedural neurological deficits. Surgical evacuation of the hematoma was performed in two patients while in remaining two patients, surgery was initially recommended but not performed since symptoms were progressively improved. Three patients showed near complete recovery except for one patient who recovered with residual deficits. Although, spinal epidural hematoma is a rare condition, it can lead to serious complications like spinal cord compression. Therefore, it is important to be cautious while performing spinal pain control procedure to avoid such complications. Surgical treatment is an effective option to resolve the spinal epidural hematoma.     

快速自然消散的颅内血肿

目的 为探讨快速自然消散的颅内血肿的消散机理及临床特点。方法回顾性分析17例快速自然消散的颅内血肿的临床表现及CT特征。结果 72h内17例颅内血肿8例明显缩小，9例完全消散。结论快速自然消散的急性硬膜外血肿多发生于青少年，与血肿部位的颅骨骨折有关；而急性硬膜下血肿的快速消散与CSF向硬膜下腔移行、冲洗以及颅内压增高对血肿的挤压或脑萎缩对血肿的再分布提供空间有关。     

Cervical Spinal Epidural Hematoma Following Cervical Posterior Laminoforaminotomy

A 65-year-old man who had lateral cervical disc herniation underwent cervical posterior laminoforaminotomy at C5-6 and C6-7 level right side. During the operation, there was no serious surgical bleeding event. After operation, he complained persistent right shoulder pain and neck pain. Repeated magnetic resonance image (MRI) showed diffuse cervical epidural hematoma (EDH) extending from C5 to T1 level right side and spinal cord compression at C5-6-7 level. He underwent exploration. There was active bleeding at muscular layer. Muscular active bleeding was controlled and intramuscular hematoma was removed. The patient''s symptom was reduced after second operation. Symptomatic postoperative spinal EDH requiring reoperation is rare. Meticulous bleeding control is important before wound closure. In addition, if patient presents persistent or aggravated pain after operation, rapid evaluation using MRI and second look operation is needed as soon as possible.     

Chronic Spinal Epidural Hematoma Related to Kummell's Disease

Chronic spinal epidural hematoma related to Kummell''s disease is extremely rare. An 82-year-old woman who had been managed conservatively for seven weeks with the diagnosis of a multi-level osteoporotic compression fracture was transferred to our institute. Lumbar spine magnetic resonance images revealed vertebral body collapse with the formation of a cavitary lesion at L1, and a chronic spinal epidural hematoma extending from L1 to L3. Because of intractable back pain, a percutaneous vertebroplasty was performed. The pain improved dramatically and follow-up magnetic resonance imaging obtained three days after the procedure showed a nearly complete resolution of the hematoma. Here, we present the rare case of a chronic spinal epidural hematoma associated with Kummell''s disease and discuss the possible mechanism.     

Unintended Complication of Intracranial Subdural Hematoma after Percutaneous Epidural Neuroplasty

Percutaneous epidural neuroplasty (PEN) is a known interventional technique for the management of spinal pain. As with any procedures, PEN is associated with complications ranging from mild to more serious ones. We present a case of intracranial subdural hematoma after PEN requiring surgical evacuation. We review the relevant literature and discuss possible complications of PEN and patholophysiology of intracranial subdural hematoma after PEN.     

Spontaneous Intracranial Epidural Hematoma Originating from Dural Metastasis of Hepatocellular Carcinoma

Spontaneous intracranial epidural hematoma (EDH) due to dural metastasis of hepatocellular carcinoma is very rare. A 53-year-old male patient with hepatocellular carcinoma, who was admitted to the department of oncology, was referred to department of neurosurgery because of sudden mental deterioration to semicoma with papillary anisocoria and decerebrate rigidity after transarterial chemoembolization for hepatoma. Brain computed tomography (CT) revealed large amount of acute EDH with severe midline shifting. An emergent craniotomy and evacuation of EDH was performed. Active bleeding from middle cranial fossa floor was identified. There showed osteolytic change on the middle fossa floor with friable mass-like lesion spreading on the overlying dura suggesting metastasis. Pathological examination revealed anaplastic cells with sinusoidal arrangement which probably led to spontaneous hemorrhage and formation of EDH. As a rare cause of spontaneous EDH, dural metastasis from malignancy should be considered.     

Epidural Hematoma Related with Low-Dose Aspirin : Complete Recovery without Surgical Treatment

Hemorrhagic complications associated with aspirin use occur primarily at skin or gastrointestinal sites but can occasionally occur in the central nervous system. In particular, spontaneous spinal epidural hemorrhage (SSEH) associated with aspirin is very rare. We report a case of low-dose (100 mg daily) aspirin-related SSEH that was successfully treated with medical management. Our case indicates that low-dose aspirin could induce SSEH and that conservative treatment with close observation and repeated imaging studies should be considered in cases with neurological improvement or mild deficits.     

Acute Cervical Subdural Hematoma with Quadriparesis after Cervical Transforaminal Epidural Block

Cervical epidural steroid injection is frequently used in the conservative management of neck pain and cervical radiculopathy. Epidural cervical transforaminal injections are usually well-tolerated with mild side effects such as transient decreased sensory and motor function, or headache due to dural puncture. Although there are a few case reports about adverse effects of cervical epidural injection in the literature, it can cause severe complications such as large hematoma, infarction by spinal vascular injury. Subdural hematoma has been occurred much less common rather than epidural hematoma in the spinal cord. We report a rare catastrophic case of cervical spinal subdural hematoma with quadriparesis after cervical transforaminal epidural block.     

迟发性硬脑膜外血肿所致的术中急性脑膨出

目的 分析急性颅脑损伤后开颅血肿清除术中急性脑膨出的原因。方法 对发生于近5年内开颅血肿清除术中发生的急性脑膨出患者进行统计,总结其中迟发性硬脑膜外血肿发生情况。结果 5年中发生于颅脑损伤后开颅血肿清除术中的急性脑膨出患者75例,其中迟发性外伤性硬脑膜外血肿25例(25/75),占同期外伤性硬脑膜外血肿的5.1％。死亡6例,死亡率为24％(6/25)。结论 颅脑损伤后减压术中出现原因不明的颅内压增高、脑膨出时,应首先排除迟发性硬脑膜外血肿的可能,以防漏诊,延误治疗。     

伴有“漩涡征”的急性硬膜外血肿的手术治疗体会

目的探讨伴有“漩涡征”的急性硬膜外血肿的临床特点和治疗方法。方法回顾性分析2005年7月至2007年8月我院收治的20例伴有“漩涡征”的急性硬膜外血肿患者的临床资料，并将其死亡率与同期不伴有“漩涡征”的急性硬膜外血肿患者的死亡率进行统计学分析。结果这加例伴有“漩涡征”的急性硬膜外血肿病人中，治愈8例，轻残3例，重残2例，死亡7例（35．0％。7／20）。伴有“漩涡征”的急性硬膜外血肿患者的手术死亡率明显高于不伴有“漩涡征”者（P〈0．01）。结论对于伴有“漩涡征”的急性硬膜外血肿，应引起足够重视，早期诊断，及时积极手术治疗，才能降低死亡率。     

Intradural Lumbar Disc Herniations Associated with Epidural Adhesion : Report of Two Cases

Intradural lumbar disc herniation (ILDH) is rare. In this report, authors present 2 cases of ILDHs associated with severe adhesion between the dural sac and posterior longitudinal ligament. In a 40-year-old man, ILDH occurred in association with epidural adhesion due to ossification of the posterior longitudinal ligament (OPLL). In other 31-year-old man, ILDH occurred in presence of epidural adhesion due to previous spine surgery.     

Spontaneous Spinal Epidural Hematoma of Unknown Etiology: Case Report and Literature Review

Introduction  Our objective is to emphasize the importance of recognizing and rapidly treating spontaneous spinal epidural hematoma (SSEH). SSEH is a pathologic entity traditionally thought to be exceptionally rare but which, in the era of MR imaging, is becoming increasingly prevalent, and which if treated with sufficient rapidity can be completely curable. Clinical Presentation  Our particular case presented with clumsiness, neck pain with radiation to both arms, and bilateral arm weakness. According to the literature surveyed, most patients present with severe back and/or neck pain, often with a radicular component, followed by motor and/or sensory deficits. Intervention/Technique  C5-6 decompressive hemilaminectomy with evacuation of hematoma. Conclusion  As evidenced in the literature, outcome depends on time to operation and prognosis is impacted by age and preoperative deficit. Because of the high risk of poor outcome without treatment, SSEH should always be a diagnostic consideration in patients whose presentation is even slightly suggestive. Rapid, appropriate treatment of these patients can often lead to complete recovery of function, whereas any delay in appropriate treatment can be catastrophic.