Bilateral traumatic extradural haematomas: report of 12 cases with a review of the literature

doi:10.1016/0303-8467(92)90069-F

Clinical Neurology and Neurosurgery

Volume 94, Issue 2, July 1992, Pages 127-131

https://doi.org/10.1016/0303-8467(92)90069-F Get rights and content

Abstract

We are reporting 12 cases of traumatic bilateral extradural haematomas. The incidence was 4.8% of all cases of extradural haematomas. The most common site was the frontal region. CT scan examination was necessary for early diagnosis. Ten patients were operated upon while one patient was treated conservatively. Two patients died. The relevant literature is reviewed.

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Cited by (25)

The unmet global burden of cranial epidural hematomas: A systematic review and meta-analysis
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Citation Excerpt :
Table 2 demonstrates event rates. Our meta-analysis found an overall incidence of EDH as 8.2 % of TBI patients (95 % CI: 5.9,11.2), with no evidence of a difference between the rate of 9.2 % (95 % CI 6.4, 13.2) in HICs and 5.8 % (95 % CI: 3.1, 10.7) in LMICs (p-value comparing the 2 groups = 0.20) (Fig. 2) [16–20,23,24,26,30,32–35,38,41,43,46,48–51,53–55,58,61,62]. Strong heterogeneity was found amongst the studies from HICs (I2 = 98.4 %, p < 0.001) and LMICs (I2 = 99.1 %, p < 0.001).
Approximately 69 million people suffer from traumatic brain injury (TBI) annually. Patients with isolated epidural hematomas (EDH) with access to timely surgical intervention often sustain favorable outcomes. Efforts to ensure safe, timely, and affordable access to EDH treatment may offer tremendous benefits.
A comprehensive literature search was conducted. A random-effects model was used to pool the outcomes. Studies were further categorized into groups by World Bank Income classification: high-income countries (HICs) and low- and middle-income countries (LMICs).
Forty-nine studies were included, including 36 from HICs, 12 from LMICs, and 1 from HIC / LMIC. Incidence of EDH amongst TBI patients 8.2 % (95 % CI: 5.9,11.2), including 9.2 % (95 %CI 6.4,13.2) in HICs and 5.8 % (95 % CI: 3.1,10.7) in LMICs (p = 0.20). The overall percent male was 73.7 % and 47.4 % were caused by road traffic accidents. Operative rate was 76.0 % (95 %CI: 67.9,82.6), with a numerically lower rate of 74.2 % (95 %CI: 64.0,81.8) in HICs than in LMICs 82.9 % (95 %CI: 65.4,92.5) (p = 0.33). This decreased to 55.5 % after adjustment for small study effect. The non-operative mortality (5.3 %, 95 %CI: 2.2,12.3) was lower than the operative mortality (8.3 %, 95 %CI: 4.6,14.6), with slightly higher rates in HICs than LMICs. This relationship remained after adjustment for small study effect, with 9.3 % operative mortality compared to 6.9 % non-operative mortality.
With an overall EDH incidence of 8.2 % and an operative rate of 55.5 %, 3.1 million people worldwide require surgery for traumatic EDH every year, most of whom are in prime working age. Given the favorable prognosis with treatment, traumatic EDH is a strong investment for neurosurgical capacity building.
Closed Head Injury
2018, Principles of Neurological Surgery
Closed head injury
2012, Principles of Neurological Surgery
Neurologic Evaluation and Management
2012, Oral and Maxillofacial Trauma
Simultaneous bilateral extradural haematoma
2005, Neurocirugia
Los hematomas epidurales constituyen una de las complicaciones más frecuentes de los traumatismos craneales. Los hematomas bilaterales son muy poco frecuentes, se asocian a traumatismos de gran intensidad y se acompañan de una elevada mortalidad.
Analizar los 6 casos de hematoma epidural bilateral (HEB) tratados en los últimos 24 años que representan el 2.5% de todos los hematomas epidurales intervenidos quirúrgicamente en el mismo período de tiempo.
La serie esta formada por 5 varones y 1 mujer con una edad media de 32.6 años (rango 16–55). Clínicamente todos presentaban disminución del nivel de consciencia. En 3 pacientes el hematoma sobrepasaba la línea media, y en los otros 3 las localizaciones eran diversas. Se apreció fractura de cráneo en la totalidad de los pacientes. Todos los hematomas fueron tratados quirúrgicamente y la mortalidad operatoria fue del 50%.
El hematoma epidural bilateral es una entidad clínica poco frecuente y cuyo pronóstico depende fundamentalmente de la situación neurológica preoperatoria.
Epidural haematomas are one of the most common complications of closed head injuries. Bilateral extradural haematomas are rare, usually acute, and generally associated with severe trauma and a high mortality.
The purpose of this paper is to present six cases of bilateral extradural haematomas seen at our service during the last 24 years and found a incidence of 2.5% of all cases of extradural haematomas surgically treated.
There were 5 males and 1 female with a mean age of 32.6 years (range 16–55). In 3 cases haematoma was across the midline and in the other 3 cases haematomas was found at different locations on cither side. Skull fracture was present in all cases. Surgical approach was the primary treatment in all cases. Mortality in our series was 50%.
Bilateral extradural haematomas is a rare condition and the prognosis is mainly dependent of the pre-operative neurological state.
Sequentially evolved bilateral epidural haematomas
2002, Clinical Neurology and Neurosurgery
Sequentially evolved bilateral epidural haematomas, where the second haematoma evolves after surgical removal of the first haematoma, are rarely reported. We report two cases of this entity. One patient was involved in a road traffic accident and the other was suffering from a head injury after an assault. CT scans showed that both patients had an unilateral epidural haematoma with a thin presumably epidural haemorrhage on the opposite side. Both patients were operated for their epidural haematomas, but did not improve after surgical treatment, and postoperative CT scans revealed evolving of an epidural haematoma on the opposite side. After evacuation of the second epidural haematoma both patients recovered quickly. Sequentially evolved bilateral epidural haematomas are rare, but must be considered in the postoperative intensive care treatment in patients with epidural haematomas. Both cases emphasize the need for intensive care monitoring after an operation for an epidural haematoma and the need for CT scans if the patient does not improve quickly after removal of the haematoma. This is especially important if a small contralateral haematoma is seen on the initial CT scan.

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Original articleBilateral traumatic extradural haematomas: report of 12 cases with a review of the literature

Abstract

Lancet

Surg. Neurology

Lancet

Observations on extradural haematoma

Br. J. Surg.

Ipsilateral double epidural haematoma

Neurol. Ind.

Case of bilateral middle meningeal haemorrhage

J. Med. Assoc. S. Afr.

Head injuries: pathophysiology

J. Ark. Med. Soc.

Extradural haematoma: experience with 167 patients

J. Neurosurg.

Subacute bilateral extradural haematoma

Neurol. Ind.

Bilateral supra and infratentorial extradural haematoma with hydrocephalus

Neurol. Ind.

Frontal extradural haematoma

Surg. Neurol.

A study of 1500 cases of head injury in Delhi

J. Ind. Med. Assoc.

Extradural haematoma. Report of 167 cases

J. Neurosurg.

Extradural haemorrhage

Neurol. Ind.

Original article
Bilateral traumatic extradural haematomas: report of 12 cases with a review of the literature