ABSTRACT
OBJETIVO: Os autores apresentam uma série de casos de hematoma extradural da fossa posterior (HEDFP) com expansão supratentorial. MÉTODOS: O presente trabalho é retrospectivo e descritivo. Foram analisados 14 pacientes com HEDFP de apresentação mista. RESULTADOS: Dos 14 pacientes, 12 são do gênero masculino e dois, do feminino. A média das idades foi de 26,2 anos. Acidente de trânsito foi a principal causa, seguida de queda acidental e agressão física. Escore na escala de coma de Glasgow variou entre 8 e 14. Cefaleia e vômitos foram os principais achados clínicos. Exame de RX simples de crânio demonstrou traço de fratura em 80% (8/10) dos casos. Tomografia de crânio demonstrou traço de fratura e hematoma extradural mista em todos os pacientes e ressonância magnética em um caso. Cirurgia foi realizada em 12 e tratamento conservador em dois. Dois pacientes foram a óbito. CONCLUSÃO: Na presença de fratura no osso occipital, deve-se suspeitar de HEDFP de forma mista. Exames de imagens são importantes no diagnóstico e conduta.
OBJECTIVE: The authors present a case series of HEDFP with supratentorial expansion. METHODS: This study is retrospective and descriptive. We analyzed 14 patients with HEDFP presentation mixed. RESULTS: Of 14 patients, 12 males and two females. Mean age was 26.2 years. Traffic accidents were the leading cause, followed by accidental fall and assault. Score on the Glasgow coma scale ranged between 8 and 14. Headache and vomiting were the main clinical findings. Examination showed RX plain skull fracture line in 80% (8/10) of cases. Cranial CT scan showed the fracture line and epidural hematoma mixed in all patients and magnetic resonance one case. Surgery was performed in 12 and conservative in two. Two patients died. CONCLUSION: In the presence of occipital bone fracture should be suspected HEDFP mixed basis. Imaging techniques are important for diagnosis and management.
Subject(s)
Humans , Male , Female , Adult , Cranial Fossa, Posterior , Craniocerebral Trauma/surgery , Craniocerebral Trauma/therapy , Hematoma, Epidural, Cranial , Hematoma, SubduralABSTRACT
Introducción: Las fracturas son generalmente clasificados como simples (cerrada) o compuesta (abierta). En el caso de las fracturas de cráneo, pueden ser fracturas lineales, elevados, o triturado con la depresión. Fractura de cráneo compuesta rara vez se ha reportado en la literatura médica y cursa con una alta morbilidad y mortalidad. Los autores presentan seis casos de fracturas múltiples del cráneo, hablan sobre el tratamiento y pronóstico. Pacientes y métodos: Se analizaron seis casos de fractura compuesta del cráneo. Analizado por sexo, causa, localización, diagnóstico, tratamiento y pronóstico. Resultados: El sexo 5M / 1F. La edad media fue de 22 a. Las causas fueron: tres por agresión física, dos por accidente de coche y uno por explosión de neumático. Todos los pacientes fueron sometidos a TC. GCS medio al ingreso fue de 8. El tratamiento quirúrgico fue instituido en todos los casos. Tres pacientes desarrollaron infecciones (meningitis 2, empiema 1). Las secuelas fueron tres convulsiones, trastornos de la conducta 2. Hubo una muerte. Conclusión: La fractura compuesta del cráneo es rara y depende de la superficie del objeto y energía cinética. Las fracturas compuestas del cráneo con fragmentos de la depresión, son más frecuentes debido a la fuerza que se aplica hacia el cráneo. Su tratamiento inicial es quirúrgico y frecuentemente evoluciona con un mal pronóstico.
Introduction: Fractures are usually classified as simple (closed) or compound (open). In the case of skull fractures, they may be linear, high, or comminuted fracture with subsidence. The compound skull fracture has been rarely reported in medical literature and courses with high morbidity and mortality. The authors present six cases of compound fractures of the skull, discuss the treatment and prognosis. Patients and methods: We reviewed six cases of compound fracture of the skull. Analyzed according to gender, causes, location, diagnostic, treatment and prognosis. Results: The gender 5M / 1F. The mean age was 22 a. The two causes were physical aggression 3, car accident 2 and explosion of a tire 1. All patients underwent CT. Average score on ECG in admission 8. Surgical treatment was instituted all cases. Sequels were seizures 3 and behavioral disorders 2. There is one death. Conclusion: The compound fracture of the skull is rare and depends on the surface of blunt object and kinetic energy. The compound skull fractures with fragments of depression are more common, due to the force that is applied toward the skull. The initial treatment is surgical, and usually evolves with poor prognosis.