Epidural Hematoma: A Prospective Analysis of Morbidity and Mortality in 173 Patients / Hematoma epidural: Uma análise prospectiva de morbidade e mortalidade em 173 pacientes

Objectives A few recent studies have focused on epidural hematomas (EDHs) that are routine in emergency rooms. The study was to evaluate the latest situation of affected patients by encephalic trauma associated with EDH in our service. Methods Prospective study between September 1, 2003 and May 30, 2009. Data were computed regarding age, sex, trauma mechanism, qualification by Glasgow coma scale admission, presence of anisocoria, and evaluation by the recovery of Glasgow scale high, with all patients by computed tomography (CT) scan. Results Among the 173 analyzed patients, mortality reached 20 patients (11.5%). Mortality was higher in the subgroup of 76 patients (44%) admitted with Glasgow coma scale (GCS ≤ 8) with 17 deceased, corresponding to 85% of total deaths. Prevalence of male subjects (140 cases, 81%) with bruises located in the temporal, frontal and parietal regions; 147 (85%) patients underwent neurosurgical treatment by craniotomy. The worst prognosis was in patients with hematomas of higher-volume (50 mL), midline structures deviations greater than 1.5 mm and basal cisterns CSF closed. Conclusion The authors emphasize the correct indication of neurosurgery and the postoperative intensive care unit (ICU) as key factors for success in the treatment of patients with EDHs.

Objetivos Poucos estudos atuais tem focado os hematomas epidurais que são rotina nos serviços de emergência. O estudo teve por objetivo avaliar a situação mais recente dos doentes acometidos por traumatismo crânio ancefálico associado a hematoma epidural no nosso serviço. Métodos Estudo prospectivo entre 1 de setembro de 2003 a 30 de maio de 2009. Foram computados dados referentes a idade, sexo, mecanismo do traumatismo, qualificação pela escala de coma de Glasgow` a admissão, presença de anisocoria e avaliação pela escala de recuperação de Glasgow na alta, tendo todos os pacientes realizado tomografia de crânio. Resultados Dentre os 173 pacientes analisados encontramos mortalidade de 20 pacientes (11,5%). No subgrupo de 76 pacientes (44%) admitidos em escala de coma de Glasgow (ECGLa) ≤ 8 pontos, a mortalidade foi superior com 17 óbitos, correspondendo a 85% do total de óbitos. Prevaleceram indivíduos do sexo masculinos (140 casos, 81%) com hematomas localizados na região temporal, seguido pelas regiões frontal e parietal; 147 (85%) foram submetidos a tratamento neurocirúrgico por craniotomia. O prognóstico foi pior nos pacientes com hematomas de volume superior a 50 mL, desvios de estruturas de linha mediana maiores que 1,5 mm e cisternas liquóricas basais fechadas. Conclusões Os autores enfatizam a correta indicação da neurocirurgia e o pósoperatório na unidade de terapia intensiva como fatores chave para o bom resultado no tratamento dos doentes com hematomas epidurais.

Extradural hematoma following double valve replacement under cardiopulmonary bypass: A rare complication.

The primary mechanisms responsible for acute neurological deterioration following cardiopulmonary bypass (CPB) include cerebral embolism, cerebral hypoperfusion and/or inflammatory process triggered by CPB. Extradural hematoma (EDH) following CPB is rare but associated with significant mortality and morbidity. We present a case of EDH following double valve replacement in an adolescent boy.

Análise epidemiológica de 210 casos de hematoma extradural traumático tratados cirurgicamente / Epidemiological analysis of 210 cases of surgically treated traumatic extradural hematoma

OBJETIVO: Analisar aspectos da epidemiologia, apresentação clínica e radiológica de pacientes com hematoma extradural traumático (HED) submetidos a procedimento neurocirúrgico. MÉTODOS: Foi realizada a revisão de prontuários de 210 pacientes admitidos no Serviço de Emergência com HED diagnosticados através de tomografia computadorizada, tratados cirurgicamente no período de agosto de 1998 a janeiro de 2008. Foram analisados: idade, sexo, apresentação clínica e radiológica, mecanismo de trauma e status neurológico no momento da alta hospitalar. RESULTADOS: Em 49,2% o mecanismo de trauma foi queda; 89,2% dos pacientes eram do gênero masculino; 49,7% dos casos tinham Escala de Coma de Glasgow (ECG) entre 13-15; 61% dos pacientes tinham idade entre 20-49 anos; A localização do HED em 26,5% e 19,6% dos casos foi têmporo-parietal e temporal, respectivamente; 32,8% tinham lesões intracranianas associadas, sendo a fratura craniana evidenciada em cerca de 45% dos casos; 76,2% dos pacientes tratados cirurgicamente tiveram alta com déficit mínimo ou ausência de déficit neurológico. CONCLUSÃO: Observamos que o HED, na população de estudo, apresenta-se mais frequentemente no gênero masculino, na quarta década de vida, mais relacionado às quedas. Na admissão, observamos uma ECG entre 13 e 15, sendo pertinente mencionar o envolvimento da região têmporo-parietal na maioria dos casos. Acreditamos que o conhecimento da epidemiologia do hematoma extradural traumático pode auxiliar na elaboração de medidas de saúde pública, visando à prevenção e identificação precoce desta doença em determinada população.

OBJECTIVE: To assess the epidemiology, clinical and radiological presentation of patients with traumatic extradural hematoma (EDH) undergoing neurosurgical procedures. METHODS: We performed a chart review of 210 patients admitted to the emergency department with EDH diagnosed by CT scan and surgically treated between August 1998 and January 2008. Variables analyzed were: age, gender, clinical and radiological presentation, mechanism of injury and neurological status at discharge from hospital. RESULTS: In 49.2% trauma mechanism was fall; 89.2% of patients were male, 49.7% of cases had a Glasgow Coma Scale (GCS) between 13 and 15; 61% of patients had age between 20 and 49 years; the location of EDH was the temporo-parietal and temporal in 26.5% and 19.6% of the cases, respectively; 32.8% had associated intracranial lesions, with skull fractures seen in around 45% of cases; 76.2% of surgically treated patients were discharged with minimal or no neurologic deficit. CONCLUSION: We observed that, in the study population, EDH appears more often in males, in the fourth decade of life, and is more related to falls. On admission, GCS was observed between 13 and 15 and it is appropriate to mention the involvement of the temporo-parietal region in most cases. We believe that knowledge of the epidemiology of traumatic epidural hematoma can assist in developing public health measures aimed at prevention and early identification of this disease in the population.

Epidemiological analysis of 189 cases of traumatic intracranial extradural hematoma treated by surgery / Análisis epidemiológico de 189 casos de hematoma epidural tratados quirúrgicamente

Objective: To analyze the epidemiology, clinical and radiological presentation of patients with extradural hematoma (EDH) who underwent surgery in our service and their neurological status at the time of discharge. Method: We reviewed the charts of 189 patients who were admitted to our service with EDH and were treated surgically, during the period of August 1998 to January 2007. Results: In 49.2 percent the mechanism of trauma was falling; 49.7 percent of the cases had GCS between 13-15; 45.0 percent had skull fractures; 32.8 percent had associated intracranial injuries. Conclusion: We observed that 76.2 percent of surgically treated patients were discharged with minimum or no neurological deficits.

Acute bilateral extradural hematomas.

The occurrence of bilateral extradural hematomas is an uncommon consequence of craniocerebral trauma and its incidence is variable in various studies ranging from 2-25%.1 We studied all cases of head injury brought to our institute over a period of 6 months and found the incidence of bilateral extradural hematomas to be 13.3%.