Akut Posterior Fossa Subdural Hematom

Akut posterior fossa subdural hematom nadir olarak gözlenir ve çoğu travmaya bağlıdır. Travmatik olmayanlar ise anti-koagulan tedavi görmüş yada idiopatik trombositopenik purpura hastalarında rapor edilmiştir. Çalışmamızda ani ve ciddi oksipital baş ağrısı ile birlikte halsizlik, tekrarlayan kusmalar, dengesiz duruş ve yürüyüşü olan iranlı 57 yaşındaki bir erkek rapor edilmiştir. Bu kişi hipertansiyon veya diabet hastası değildir. Başında travma geçmişi bulunmamaktadır ve kişi uyuşturucu yada alkol kullanmadığını söylemektedir. Akut intra serebral hemoraji için ön bir tanı yapıldı. CT beyin taraması, posterior fossa bölgesinde sağ taraflı, ekstra aksiyal hilal şeklinde yoğunlaşmış bir alan olduğunu gösterdi. Rutin kan testleri, kanama zamanı, koagülasyon durumu ve trombosit sayımı normaldi. Hastada spontan gelişen akut infratentoryal subdural hematom vardı. Hasta tedavi edildi ve 5 gün sonra iyi bir şekilde taburcu edildi. O zamandan beri hasta klinik olarak veya radyolojik olarak takip edilemedi, çünkü hasta irana geri döndü. Hastanın durumu, klinik seyiri ve görüntüleri konservatif bir yönetim gerektirmiştir. Dolayısıyla genel anlamda hastanın durumu nispeten iyi olsada, CT beyin taramasını iyi yorumlanmadıkça ve olası teşhis konusunda önceden fikir sahibi olunmadıkca hastalık kolayca gözden kaçabilir.

Anahtar Kelimeler:

Akut subdural hematom, posterior fossa, serebral basınç, spontan, ataksi

Acute Spontaneous Posterior Fossa Subdural Hematoma

Acute posterior fossa subdural hematomas are rare and most of them are trauma-related. Non-traumatic ones have been reported in patients who had idiopathic thrombocytopenic purpura or those who had been receiving anticoagulant therapy. We report on the case of 57-year-old Iranian man who developed sudden severe occipital headache, drowsiness, repeated vomiting, and instability of stance and gait. He was neither hypertensive nor diabetic. No history of head trauma was obtained and he denied illicit drug or alcohol ingestion. A preliminary diagnosis of acute intra-cerebellar hemorrhage was made. His CT brain scan revealed an acute right-sided, extra-axial, crescent-shaped hyperdense area at the posterior fossa. His routine blood tests, platelets count, bleeding time, and coagulation profile were unremarkable. The patient had spontaneous acute infratentorial subdural hematoma. He was treated conservatively and discharged home well after 5 days. Since then, we could not follow-up him, clinically and radiologically because he went back to Iran. Our patient"s presentation, clinical course, and imaging study have called for conservative management, as the overall presentation was relatively benign. Unless the diagnosis is entertained and the CT brain scan is well-interpreted, the diagnosis may easily escape detection.

Keywords:

acute subdural hematoma; posterior fossa; cerebellar compression; ataxia; spontaneous,

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Yazışma Adresi / Address for Correspondence: Osama Shukir Muhammed Amin Sulaimaniya City Post-Office, PO BOX 196, Sulaimaniya City, IRAQ e-mail: dr.osama.amin@gmail.com geliş tarihi/received :28.08.2012 kabul tarihi/accepted:25.09.2012 .