Delayed epidural hematoma after head injury

Abstract EN

Objective : Since the routine introduction of CT scan as a main diagnostic tool in head trauma, delayed epidural hematoma (DEDH) has been defined as separate entity and more patients have been reported in the medical literature.

This paper describes the characteristics, including the path gnomic, clinical, and surgical aspects of DEDH, based on the data of our patients and of the patients reported in the literature.

Methods : Our retrospective clinical study includes nine patients of space-occupying traumatic DEDH out of 112 patients of traumatic epidural hematomas, treated in Aleppo University Hospital, from the beginning of 2006 till the end of 2010.

These hematomas were not present or minimal on the computerized tomography scans (CT scans) done immediately after trauma, but were evident on the repeated CT scans, which were performed 24-48 hours later.

The precursor of DEDH was the neurological deterioration in seven patients, repeated epileptic fits followed by lethargy in one patient, and progressive headache accompanied by repeated vomiting in one patient.

Eight patients (almost 89 %) were treated surgically.

Results : Outcome of all managed patients was very good.

Clinical follow up was done in all studied patients every month for the first 6 months after trauma.

All operated patients did very well in the postoperative follow up period, and none of them suffered postoperative neurological sequelae attributed to the previously mentioned mode of management.

Overall mortality rate in the studied patients was nil.

Conclusions : Awareness of the possibility of occurrence of DEDH as a complication of head injury, repeat CT scan in case of any neurological deterioration and proper management are essential factors for improving the outcome of affected patients.