Kafa travması sonrası gelişen geç epidural hematom

Travmatik geç epidural hematomlar, travma sonrası yapılan ilk nöroradyolojik değerlendirmede görülmeyip sonraki değerlendirmelerde ortaya çıkan kanamalardır. Geç dönemde ortaya çıkan epidural hematomların venöz kaynaklı olduğu düşünülmektedir. Çocukluk çağındaki geç kanamalarda, kanın epidural mesafedeki yavaş birikimi tanı koymayı geciktirebilir. Bu yazıda, yüksekten düşme sonrası acil servise başvuran ve nörolojik bulgusu olmayıp ilk bilgisayarlı beyin tomografisi (BBT)'inde sağ pariyetal lineer fraktür hattı dışında radyolojik bulgu saptanmayan, hastaneye başvurmasından 6 saat sonra nöbet geçirip bilincinin kapanması üzerine çekilen ikinci BBT'sinde epidural hematom saptanarak boşaltılan bir olgu sunulmuştur. Bu olgu sunumu ile geç travmatik epidural hematomlarda geri dönüşümsüz beyin hasarı olmadan tanının konularak hızlı müdahale edilmesinin mortaliteyi azaltacağı vurgulanmıştır.

Delayed epidural hematoma after mild head injury

Traumatic delayed epidural hematomas are hematomas that are not present in the first neuroradiologic examination made after trauma, but appear in sequential neuroradiologic examinations. The origin of delayed epidural hematomas is thought to be venous bleeding. In childhood period, slow accumulation of the blood through the epidural space in the late hematomas may delay the diagnosis. In this report, we present a case seen in the emergency department after fall from a height with normal neurological evaluation. The initial cranial computed tomography (CT) revealed no hematoma apart from right parietal linear fracture. The second cranial computed tomography which was taken 6 hours after admission to the hospital, when he had a seizure and became unconscious showed an epidural hematoma. It was excavated surgically immediately. In this case report, we emphasize that early diagnosis of the delayed traumatic epidural hematomas before the irreversible brain injury and rapid surgical treatment will decrease the mortality.

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1) Rivas JJ, Lobato RD, Sarabia R, et al. Extradural hematoma: An analysis of factors influencing the course of 161 patients. Neurosurg 1988;23:44-51.
2) Borovich B, Braun J, Guilburd J, et al. Delayed onset of traumatic extradural hematoma. J Neurosurg 1985;63:30-34.
3) Poon W, Rehman S, Poon C, Li A. Traumatic extradural hematoma of delayed onset is not a rarity. Neurosurgery 1992;30(5):681-686.
4) Tahta K. Travmatik intrakranyal hematomlar. In: Aksoy K, Palaoğlu S, Pamir N, Tuncer R. Temel Nöroşirürji (1st ed) Ankara, 2005;325-332.
5) Schutzman SA, Barnes PD, Mantello MM et al. Epidural hematomas in children. Ann Emerg Med 1993;22:535-541.
6) Ashkenazi E, Constantini S, Pomeranz S et al. Delayed epidural hematoma without neurological deficit. J Trauma 1990;30:613-615.
7) Milo R, Razon N, Schiffer J. Delayed epidural hematoma: A review. Acta Neurochirc 1987:84;13-23.
8) Foroglou G, Patsalas I, Kontopoulos B. The timing of CT. Neurosurg Rev 1989;12:169-173.
9) Smith HK, Miller JD. The danger of an ultra-early computed tomographic scan in a patient with an evolving acute epidural hematoma. Neurosurgery 1991;29:258-260.
10) Mandavia DP, Vıllagomez J. The importance of serial neurologic examination and repeat cranial tomography in acute evolving epidural hematoma. Pediatric emergency care 2001;17;193-195.
11) Riesgo P, Piquer J, Botella C, Orozco M, Navarro J, Cabanes J. Delayed extradural hematoma after mild head injury: report of three cases. Surg Neurol 1997; 48:226-231.
12) Summers LE, Mascott CR. Delayed epidural hematoma: presentation in a pediatric patient. J La State Med Soc 2001;153:81-84.
13) Durham SR, Liu KC, Selden NR. Utility of serial computed tomography imaging in pediatric patients with head trauma. J Neurosurg. 2006;105:365-369.
14) Kutlay M, Çolak A, Kıbıcı K, Demircan N,Akın ON. Travmatik gecikmiş epidural hematomlar: 7 yeni olgu ve literatürde rapor edilmiş 48 olgunun retrospektif analizi. Ulusal Travma ve Acil Dergisi 1998;4:273-280.
15) Rocco AD, Ellis SJ, Landes C. Delayed epidural hematoma. Neuroradiology 1991;33:253-254.
16) Gökalp HZ, Erongun U: Nöroşirürji ders kitabı. Ankara: Mars Matbaası, 1988:202-251.