Gigantic ossified chronic epidural haematoma and contralateral postoperative subdural haematoma: A case report and literature review

Ossification of Cranial Epidural Hematomas: A Systematic Review of Management Strategies and Presentation of an Illustrative Case

The presence of a calcified or ossified chronic cranial epidural hematoma (EDH) is rare and has been described in only a few case reports in the literature. Consequently, clear treatment strategies remain elusive and may entail conservative and surgical approaches. In this study, we performed a systematic review of reported cases to evaluate the clinical course and treatment options for these patients. A comprehensive systematic search of two databases was performed, and information on patient characteristics, symptomatology, and treatment was extracted from eligible articles. A total of 56 cases were included in our analyses. Forty patients were male, 16 were female, with an average age of 21.38 years at the time of diagnosis. Assumed etiology was previous trauma in 35 cases, previous cranial surgery in 17 patients, and birth trauma and epidural bleeding after the utilization of the Mayfield clamp in 1 case each. The origin remained unclear in two cases. The time between trauma or surgery and diagnostics ranged between one and a half weeks and 50 years, with a median of 4 years (SD 9.8 years). The symptoms were very heterogeneous, ranging from acute neurological deterioration to chronic symptoms. In 15 cases, patients were asymptomatic, and cranial imaging was performed as part of a new trauma or a screening for other disease. Forty-one patients received surgical treatment by craniotomy and hematoma evacuation, and 13 patients were treated conservatively. In two cases, the liquid hematoma portion was aspirated through a burr hole. The localization of calcified or ossified EDH was mainly supratentorial. Young male patients most commonly present with calcified or ossified EDH after trauma, according to the epidemiological trend of acute EDH. Clinical presentation varies from asymptomatic to severe neurological deficits and signs of increased intracranial pressure. There is no standardized treatment; decisions must be made on an individual basis.

Chronic Epidural Hematoma: Still a Rare Entity?

Introduction Extradural hematoma diagnosed more than 14 days after head injury is classified as a chronic extradural hematoma (CEDH). In the present study, we presented a series of 8 patients with CEDH in a span of 6 months.

Materials and Methods In this article, we reported 8 cases of CEDH who presented to Nil Ratan Sircar Medical College, Kolkata, West Bengal, India, within a span of 6 months.

Discussion Extratemporal epidural hematomas (EDHs) are often due to venous bleeding from the diploic veins or dural sinuses or to delayed rupture of a middle meningeal pseudoaneurysm. In these cases, cerebrospinal fluid may redistribute from the lateral ventricles and thus allowing room for the enlarging hematoma producing vague neurological symptoms and signs. The incidence rate of CEDH reported in the literature ranges from 3.9 to 30% of all EDHs. Computed tomography (CT) scan in CEDH often shows a low-density center surrounded by a high-density margin. Calcification of the displaced dura mater may also occur. Some are identified incidentally, whereas others are diagnosed when investigating for persistent and/or progressive neurological symptoms. Symptomatic CEDH should be surgically evacuated and has an excellent outcome the earlier it is done. In patients with no or mild symptoms, normal neurological status, and a small-sized CEDH spontaneous resolution may be expected.

Conclusion In the post-CT era, it is always said that CEDH is a rare entity. However, in developing countries we still encounter a large number of such cases and the question arises whether CEDH is still a rare entity.

Spontaneous acute epidural hematoma associated with chronic subdural hematoma due to dural metastasis of gastric carcinoma: a case report and literature review

Background: Non-traumatic spontaneous acute epidural hematoma (EDH) happening to chronic subdural hematoma (SDH) caused by dural metastases is a rare entity. Pathogenesis can be derived from infection, coagulopathy, and inflammation. Malignant tumors metastasize to dura mater is one of the most infrequent causes. The exact mechanism remains elusive in spite of several possible speculations. The clinical manifestations, management and outcomes vary among reported cases.Case Description: A 45-year-old woman without history of trauma presented with headache, vomiting and disturbance of consciousness and developed brain hernia rapidly. On arival, she has lost into coma with Glasgow coma scale (GCS) score 5, bilateral pupils were not equal, with disappeared reflectance. Emergency imaging prompted large acute EDH, combined with SDH, arising from dural granular neoplasm confirmed intraoperatively. Four days after surgery, the bilateral pupils were equal in size and sensitive to light reflection.Conclusion: Dural metastases can cause EDH, chronic SDH can also be resulted from metastatic tumors of dura mater. When dealing with spontaneous non-traumatic hematoma around the dura mater, to make the precise diagnosis is sometimes doubtful and confusing. The stream of diagnostic thinking should be opened, including medical diseases such as liver and kidney disease, drug history, history of cancer and other possible clues. Thus, a detailed and purposeful systematic medical history review and physical examination is important in order to make more appropriate strategies for the clinic.