Asymmetric Bilateral Traumatic Epidural Hematoma: A Report of a Rare Traumatic Lesion / 대한신경손상학회지

Bilateral epidural hematoma is a rare presentation in head trauma injuries, accounting for only 1%–2% of all epidural hematomas, but with a higher mortality rate than the unilateral form. Herein, we report the case of a 27-year-old man admitted to our department following a road traffic accident. On admission,his Glasgow Coma Scale (GCS) score was 13/15. After a few minutes, he became comatose (GCS 6/15) with right anisocoria. CT scan revealed a bilateral asymmetric epidural hematoma with a left extralabyrinthic linear fracture. Surgical evacuation was subsequently performed, starting with the voluminous right hematoma. The patient was discharged on the 23rd postoperative day with a right third-nerve palsy. Conclusions: In this case report, we discuss the etiology, mechanism, and management of bilateral epidural hematoma. Early diagnosis and a judicious surgical approach for bilateral epidural hematoma are necessary to minimize mortality and morbidity. Prevention is key to reducing traumatic brain injuries.

Transcranial Doppler and cerebral tomodensitometry scan in the predictivity of intracranial hypertension

To compare transcranial Doppler ultrasonography [TCD] and cerebral tomodensitometry [CT], in the predictivity of intracranial hypertension [ICH]. Sixteen patients, with a median age of 47 years, under continuous monitoring of intracranial pressure [ICP] were included in a double blinded prospective study. Each time a CT was performed the left and right middle cerebral arteries were insonated. With TCD, ICH is noted if the worst mean blood flow diastolic velocity was less than 25 cm/s, associated with a pulsatility index value larger than 1.2. Cerebral tomodensitometry was analysed and the ICH noted if one or more of the following radiographic signs was present [disappearance of sulci, effacement of ventricles, reduction of the white-grey matter differentiation, basal cistern compression, hydrocephalus and midline shift higher to 5 mm]. The median initial Glasgow Coma Score was 8 +/- 3. Intracranial pressure monitoring was undertaken in the following situations: 10 severe head injury, 4 strokes and 2 cerebral tumours. A total of 30 CT were carried out. Fourteen patients presented at least one episode of ICH. During episodes of ICH, TCD correlated with ICP in 64% of the cases, whereas CT correlated with ICP in 68% of the cases. In the absence of ICH the correlation of TCD and ICP decreased to 37.5%. In 4 cases of ICH, data of CT were not in favour of ICH while TCD correlated with ICP. Associating TCD and CT allows to detect ICH in 86% of cases vs. 68% only with CT [p=0.15] and vs. 64% only with TCD [p=0.08]. Transcranial Doppler ultrasonogrpahy is equivalent to CT in the predictivity of an ICH. This predictability is better in cases of ICH [ICP > 20 mmHg]. Associating TCD to CT allows to recover the majority of the cases of ICH not detected by CT alone

Surgical management of symptomatic suprasellar arachnoid cysts

The true incidence of intracranial arachnoid cysts is unknown because many may be asymptomatic throughout life. However, with the advent of CT and MRI the frequency of the diagnosis of arachnoid cyst has significantly increased. In adults they represent 9% of all the arachnoid cysts while in paediatric population this percentage reaches 15%.The various surgical options for treating suprasellar arachnoid cysts [SSAC] include craniotomy with fenestration or marsupialization of the cyst, cystoperitoneal shunt and percutaneous ventriculocysto-cisternostomy. Ten patients with SSAC were operated on in our institution since 1992. The aim of our work consists of describing the clinical manifestations, the radiological features and the different surgical methods to treat SSAC. The patients ranged in age from one month to 33 years [mean age = 8 yrs]. The signs and symptoms are referable to the size of the cyst. All patients with SSAC underwent preoperative CT, cisternography or MRI. In 7 patients, marsupialization of the cyst was performed; in 5 patients, a cystoperitoneal shunt was placed and ventricuhocysto-cisternostomy performed in only 2 patients. Five patients were operated more than one time undergoing two different methods of surgery