Computed tomography of spinal epidural hematoma

Three cases of spinal epidural hematoma are presented. Computed tomography (CT) was the first diagnostic method used in two patients and demonstrated a surgically confirmed spinal epidural hematoma in both patients. In a third patient who presented with a complete block on myelography, CT was helpful in assessment of the extent of the lesion and suggested a vertebral hemangioma as the cause of the hematoma. CT is a very useful tool in the diagnosis of spinal epidural hematomas.     

Influence of "optical illusion" on detectability in diagnosis for head CT images: participation of optical illusion of light perception in medical image reading and diagnosis

Even if the visual impression of the photographic density of the brain in head CT images is shown as physically the same, it is known that optical illusions of lightness perception (assimilation, contrast, picture frame effect, etc.) occur and that practical density can be observed psychologically differently, according to differences in the color of the skull and background, and differences in cases (differences in picture pattern). Therefore, in this study, in order to clarify the influence of optical illusion on detectability in diagnosis, the author attempted to compare detectability in four sample cases, consisting of acute cerebral infarction (1), acute epidural hematoma (1), and chronic subdural hematoma (2), using visual subjective evaluation. In the case of acute cerebral infarction, there was no significant difference in detectability between the original image and the virtual images. Further, it clarified that the original head CT image (acute epidural hematoma) with the high-density hematoma recognized at the marginal limited part of the brain was inferior to virtual images in detectability, while it clarified that the original head CT image (chronic subdural hematoma) with the low-density hematoma was superior to virtual images in detectability, because of visual psychological emphasis on the difference of the film contrast between the hematoma and white skull.     

Delayed intracerebral hemorrhage as demonstrated by CT scanning

Summary Three patients are presented who developed delayed intracerebral hematomas after head injury. Two patients had essentially negative CT scans on admission and developed intracerbral hematomas within 24 h after injury. They required surgical treatment and had fatal outcomes. The third patient presented with an epidural hematoma on CT scan, developed an intracerebral hematoma 48 h after evacuation of the epidural hematoma, and did well with conservative management.     

Delayed epidural hematoma after evacuation of a subdural hematoma

CT easily diagnoses epidural hematomas. The appearance of an epidural hematoma may be delayed by compression from a contralateral lesion. The possibility of a delayed epidural hematoma should be kept in mind in the presence of additional findings such as a skull fracture contralateral to the original lesion or decompression of the epidural hematoma into either the subgaleal or the subarachnoid space. We present a case in which an epidural hematoma declared itself after the evacuation of a contralateral subdural hematoma.     

Delayed epidural hematoma

Summary A case of delayed epidural hematoma is described who had an initial computerized tomography (CT) scan reported as normal. Repeat CT scan at 48 h demonstrated a right temporal epidural hematoma. A skull fracture was not observed radiographically or at surgery. The world literature is reviewed and the criteria for repeat CT scanning is discussed.     

锥颅治疗慢性硬膜下血肿47例分析

目的探讨锥颅治疗慢性硬膜下血肿的疗效。方法对47例慢性硬膜下血肿患者均根据颅脑CT定位,采用经头皮直接锥颅置管冲洗引流术治疗。结果47例病人中,意识障碍、偏瘫均在1~2 d内明显好转,2周后患者生活基本能自理,记忆力恢复正常,术后全部痊愈出院,随访半年无一例复发。结论经头皮行锥颅慢性硬膜下血肿冲洗引流术操作简单、手术时间短、创伤小、并发症少、疗效高。     

CT myelography of spontaneous spinal epidural hematoma

A case of so-called spontaneous epidural hematoma is presented. A new constellation of myelographic and CT myelographic signs are described that may assist in localizing a mass within the spinal epidural space.     

Epidural hematoma as a complication of sphenoid sinusitis and epidural abscess: a case report and literature review

Imaging is of paramount importance in early diagnosis of epidural abscess and its intracranial complications. Typical CT imaging features of an epidural abscess include a hypodense lentiform extra-axial collection with rim enhancement. We present a case of epidural abscess that was hyperdense on CT scan due to the presence of associated epidural hematoma. The literature is reviewed regarding this unusual complication of epidural abscess.     

迟发性颅内血肿的CT检查

目的:分析迟发性颅内血肿的临床表现、CT复查指征及预后。对象与方法:36例颅脑外伤后临床症状进行性加重的迟发性颅内血肿患者均经CT复查,并与第1次CT检查所见比较。结果:经CT复查发现36例颅内血肿,其中,脑内血肿16例(19个病灶),硬膜下血肿7例(伴蛛网膜下腔出血1例),硬膜外血肿9例,以及混合性血肿4例。结论:当颅脑外伤病人临床症状进行性加重时,择期进行CT复查可以发现第1次CT检查未发现的颅内血肿。     

Delayed epidural hematoma after mild head injury

BACKGROUND: Traumatic delayed epidural hematoma (DEH) can be defined as insignificant or not seen on the initial CT scan performed after a trauma but seen on the subsequent CT scan as a "massive" epidural bleeding. CASE REPORT: We presented two cases of traumatic DEH after mild head injury. Both patients were conscious and without neurological deficit on the admission. Initial CT scan did not reveal intracranial hematoma. Repeated CT scan, that was performed after neurological deterioration, revealed epidural hematoma in both cases. The patients were operated with a favorable surgical outcome. CONCLUSION: Traumatic DEH could occur in the patients with head injuries who were conscious on the admission with a normal initial CT scan finding. Early detection of DEH and an urgent surgical evacuation were essential for a good outcome.     

儿童硬膜外血肿的治疗

目的 探讨儿童硬膜外血肿的临床特点及其治疗方法。方法 回顾性分析我院2001年1月～2003年12月收治的儿童硬膜外血肿120例。结果 婴幼儿和学龄前儿童受伤原因以坠落伤及摔伤为主，7岁以上儿童以交通伤为主。65.8％(79/120)的患儿合并有颅骨骨折，格拉斯哥昏迷评分(GCS)平均13．6分。急性血肿除立即手术者外，其他于首次发现血肿1d后及3d左右再复查CT。手术者占57.5％(69/120)，术中发现血肿来源于板障出血的占44％(29/66)。结论 儿童硬膜外血肿的原发颅脑损伤相对较轻，颅骨骨折的发生率低于成人，板障出血为血肿形成的首要原因。有必要做多次CT检查，经恰当治疗预后良好。     

跨窦骨瓣开颅术治疗骑跨静脉窦硬膜外血肿

目的 探讨骑跨静脉窦硬膜外血肿的手术治疗策略及疗效.方法 对43例骑跨静脉窦硬膜外血肿病例的临床资料、手术方式和预后进行回顾性分析.43例患者均采用跨窦骨瓣开颅,骨瓣复位,窦旁(周)硬脑膜悬吊于骨瓣相应位置的骨孔上.结果 43例术后第3、6天头部CT扫描显示血肿无复发、无残留,骨瓣无移位.出院时GOS预后评分:术后死亡1例,重度残疾1例,中度残疾2例,恢复良好39例.结论 跨窦骨瓣开颅术是治疗骑跨静脉窦硬膜外血肿的一种安全而且有效的方法.     

Nonoperative management of acute epidural hematoma diagnosed by CT: the neuroradiologist's role.

PURPOSE: To determine whether certain patients with epidural hematomas would benefit from conservative treatment and to assess the neuroradiologist's role in decision-making. METHODS: We reviewed the CT scan findings, clinical presentation and outcome of 48 consecutive patients with epidural hematoma managed at our institution within the past 5 years. In 18 patients, initial management was nonsurgical, and only one of these went on to require surgery due to clinical deterioration and evidence of enlargement of hematoma on CT. The remainder of these 18 did well without surgery. OBSERVATIONS AND CONCLUSIONS: Clinical indicators of neurologic dysfunction (decrease in Glasgow coma scale score, pupillary dilatation, and hemiparesis) in the presence of even small epidural hematomas usually dictates the need for surgical management. The role of the neuroradiologist is most important when the patient presents in a good clinical state, when identification of both favorable and unfavorable prognostic factors on Ct is essential. The initial diameter of nonsurgically managed epidural hematomas generally must be small (mean, 1.26 cm in our series, all under 1.5 cm), and midline shift should be minimal (mean, 1.8 mm in our series). The identification of lucent areas within the epidural hematoma (suggesting active bleeding), or CT evidence of uncal herniation, can be ominous and the neurosurgeon must be alerted to their presence. Even in the presence of a favorable clinical status, presence of a larger epidural hematoma with significant mass effect or central lucent areas should alert the neuroradiologist and neurosurgeon to the strong possibility of sudden neurologic deterioration, and indicate the probable need for surgical management.     

„Verschwinden“ des Epiduralhämatoms im Verlauf

Spontaneous rapid resolution, redistribution or drainage (disappearance) of an acute epidural hematoma within 24 h has occasionally been reported, mostly in younger traumatized persons. The mechanism could be drainage of the hematoma through an overlying skull fracture into the subgaleal and subcutaneous space caused by increasing brain swelling and intracranial pressure. This was the case in an 85-year-old cyclist who suffered severe craniocerebral trauma in a traffic accident. The epidural hematoma detected by emergency computed tomography (CT) was no longer visible in the control CT 8 h later (and the autopsy). All that was found was a massive intracerebral bleeding and accompanying brain edema.     

Acute isodense epidural hematoma on computed tomography.

Computed tomography (CT) has proven to be invaluable in the diagnosis of craniocerebral injuries. Acute epidural hematomas have been described as having a characteristic appearance on CT of a lenticular shaped area of blood density most commonly situated over the cerebral convexity. This case demonstrates an acute epidural hematoma that is essentially isodense with brain tissue.     

CT scan evidence of air presence in an epidural hematoma

CT scan evidence of air in an intracranial epidural hematoma is presented. Several conditions could be necessary to induce this unusual pathology: an associated open fracture of the cranial aeric cavities and a positive differential pressure between cavities and hematoma.     

MR demonstration of spontaneous acute epidural hematoma of the thoracic spine

Summary Two patients with spontaneous epidural hematoma of the thoracic spine are presented. The magnetic resonance (MR) examination performed within the first hours following the onset of symptoms demonstrated an epidural elongated lesion impinging on the spinal cord, compatible with hematoma. In one of the patients this finding was surgically confirmed. The second patient improved under steroid treatment. The MR findings were highly suggestive of the pathological nature of the lesion. The MR examination should replace other diagnostic procedures, such as computerised tomography (CT) and myelography.     

Chronic nontraumatic spinal epidural hematoma of the lumbar spine: MRI diagnosis

An uncommon case of chronic nontraumatic spinal epidural hematoma of the lumbar spine in a 75-year-old woman is reported. The patient presented with a 7-month history of low back pain and bilateral sciatica. Magnetic resonance imaging enabled a correct preoperative diagnosis revealing a nodular, well-circumscribed epidural mass with peripheral enhancement and signal intensities consistent with chronic hematoma, which extended from L2 to L3. Laminectomy of L2–L3 was performed and the hematoma was totally resected. Histological examination of the surgical specimen demonstrated a chronic encapsulated hematoma. No evidence of vascular malformation was found. The patient recovered fully after surgical treatment. Received: 23 August 1999; Revised: 13 January 2000; Accepted: 4 February 2000     

CT and acute head trauma.

The value of CT in the management of 500 patients with head trauma is described. In these cases CT defined the effect of edema, contusion, subdural or epidural hematoma, or hydrocephalus.     

Extravasation of constrast-enhanced blood in an epidural hematoma

Summary A case is reported in which there was a large extravasation of contrast medium into an epidural hematoma during contrast-enhanced CT.