Shinichiro Teramoto, Satoshi Tsutsumi, Hisato Ishii
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan.
Copyright: © 2020 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Shinichiro Teramoto, Satoshi Tsutsumi, Hisato Ishii. Traumatic acute epidural hematoma caused by injury of the diploic channels. 08-Oct-2020;11:333
How to cite this URL: Shinichiro Teramoto, Satoshi Tsutsumi, Hisato Ishii. Traumatic acute epidural hematoma caused by injury of the diploic channels. 08-Oct-2020;11:333. Available from: https://surgicalneurologyint.com/surgicalint-articles/10320/
Background: Traumatic acute epidural hematomas (EDHs) commonly develop by rupture of the meningeal arteries. EDH caused by an injury of the diploic channel (DC) has not been reported.
Case Description: A 21-year-old man suffered a head injury while falling off the skateboard. At presentation, the patient was drowsy but did not exhibit any focal neurological deficits. Cranial computed tomography (CT) revealed a biconvex intracranial hematoma with 18-mm thickness in the high parietal region and a linear fracture that involved both the outer and inner tables and passed above the hematoma. A well-developed and large DC was observed near the hematoma. Patient’s consciousness level decreased at 12 h after admission with considerable growth of the hematoma. A frontoparietal craniotomy revealed an EDH. The dura mater and the meningeal arteries underneath the hematoma were intact. The medial bone cut caused brisk bleeds from the large DC. Postoperative CT revealed the cut of the DC and other finer DCs exhibiting air density and lying near the fracture. Based on these findings, we assumed that the EDH was developed by an injury of the DCs.
Conclusion: Traumatic EDH can develop by an injury of the DCs. Careful observation of patient’s neurological status and precise interpretation of neuroimages is important to identify venous EDHs.
Keywords: Acute epidural hematoma, Diploic channel, Traumatic, Venous hemorrhage
Traumatic acute epidural hematomas (EDHs) are well-known entities that develop in approximately 2% of all head injuries, with mortality rates ranging from 1.2% to 33%.[
A 21-year-old, previously healthy man, suffered a head injury while falling off the skateboard and was transported to our hospital. The patient lost consciousness for 1 min immediately after the injury. At presentation, the patient was drowsy and exhibited a Glasgow Coma Scale (GCS) score of 13 without any focal neurological deficits. Cranial CT revealed a biconvex intracranial hematoma with 18-mm maximum thickness in the left high parietal region and a linear fracture coursing parallel to the sagittal suture [
Axial (a) and coronal (b) computed tomography scans at presentation show a biconvex hematoma with 18-mm thickness in the left high parietal region (arrow). Lateral (c) and superior (d) views of the three-dimensional computed tomography scans show a linear fracture in the left parietal bone passing parallel to the sagittal suture. CS : coronal suture.
(a) Bone target coronal computed tomography scan show a fracture line passing above the thickest part of an intracranial hematoma (h). A well-developed and large diploic channel is observed near the hematoma. (b) Bone target coronal computed tomography showing the magnified view of the boxed area in A. SS : Sagittal suture. DC: Diploic channel, FL: Fracture line, H: Hematoma
Axial (a) and coronal (b) computed tomography scans performed 12 h after the admission showing the growth of the hematoma with an increased thickness of 25 mm (arrow).
Intraoperative photographs on reflecting the scalp flap (a), immediately after removal of the bone flap (b), after the evacuation of the epidural hematoma (c), and after fixing the bone flap back into the original place (d) are depicted. Abnormal vasculature or injury of the dural arteries is not observed. Arrow in (b) indicates the site of a large diploic channel that was cut by the medial bone fracture caused brisk bleeds. Arrows in (a) and (d) indicate the fracture line.
(a-c) Serial bone target coronal computed tomography scans performed immediately after surgery shows the cut of a large diploic channel (DC) by the medial bone cut and other finer DCs lying in the bone flap and exhibiting air density (arrows). CL: craniotomy line, FL: fracture line, SS: sagittal suture.
Traumatic acute EDHs usually develop by ruptures of the meningeal arteries. However, based on the time course of the patient’s neurological status and neuroimaging and intraoperative findings, we assumed that the present EDH developed by injuries of the DCs. Direct anatomical connections between a well-developed and large DC that was cut during the medial bone cut and finer DCs lying near the fracture line were not demonstrated. However, postoperative CT images were highly suggestive of such connections. These DCs are presumed to correspond with the previously documented, the occipitoparietal route of the calvarial DCs that consistently connect the superior sagittal sinus and transverse sinus-sigmoid sinus junctional region.[
Anatomically, the part of the meningeal artery coursing through the high parietal region is a fine peripheral vessel that transmits a tiny amount of blood flow.[
Traumatic EDH can develop by injury of the DCs. Careful observation of patient’s neurological status and precise interpretation of neuroimages is important to identify venous EDHs.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Is epidural hematoma a traumatic brain injury? ›
The resulting condition is called an epidural hematoma, a type of traumatic brain injury (or TBI) in which a buildup of blood occurs between the outer membrane of the brain and the skull.What is the most common cause of an epidural hematoma? ›
An epidural hematoma (EDH) occurs when blood accumulates between the skull and the dura mater, the thick membrane covering the brain. They typically occur when a skull fracture tears an underlying blood vessel.What are the long term effects of epidural hematoma? ›
Other complications include permanent symptoms, such as: Herniation of the brain and permanent coma. Normal pressure hydrocephalus, which can lead to weakness, headaches, incontinence, and difficulty walking. Paralysis or loss of sensation (which began at the time of the injury)What is the survival rate of epidural hematoma? ›
Mortality rate associated with epidural hematoma has been estimated to be 5–50%. The level of consciousness prior to surgery has been correlated with mortality rate: 0% for awake patients, 9% for obtunded patients, and 20% for comatose patients. Bilateral intracranial epidural hematoma has a mortality rate of 15–20%.Is traumatic brain injury the same as brain damage? ›
You may wonder what the difference between brain damage and traumatic brain injury is. Brain damage usually is non-traumatic, while traumatic brain injury (TBI) is the result of a blow to the head, often in an accident with negligence.Is traumatic brain injury same as stroke? ›
Traumatic brain injury (TBI) is considered a risk factor for the development of stroke (Hemorrhagic Stroke and Ischemic Stroke). We performed this systemic review and meta-analysis to determine the association of prior TBI with the subsequent diagnosis of stroke.What are the signs and symptoms of an epidural Haematoma? ›
- Drowsiness or altered level of alertness.
- Enlarged pupil in one eye.
- Headache (severe)
- Head injury or trauma followed by loss of consciousness, a period of alertness, then rapid deterioration back to unconsciousness.
- Nausea or vomiting.
Because epidural hematomas typically involve an artery, bleeding and increased intracranial pressure may occur much more rapidly, requiring more urgent intervention. In contrast, though still serious, subdural hematomas involve veins which tend to bleed and grow more slowly.Is an epidural hematoma a stroke? ›
Introduction. Spinal epidural hematoma is a rare disease with an annual incidence of 1 per 1,000,000 individuals;1 however, it is a critical stroke mimic.Can a hematoma cause problems years later? ›
Many people are left with some long-lasting problems after treatment for a subdural haematoma. These can include changes to your mood, concentration or memory problems, fits (seizures), speech problems, and weakness in your limbs. There's also a risk the haematoma could come back after treatment.
Can a hematoma cause permanent nerve damage? ›
A large haematoma may press on a nerve and cause damage. Rarely, an urgent operation is required to remove the haematoma and stop it pressing on the nerve. If you take blood-thinning medicines such as warfarin or clopidogrel, you are more likely to get a haematoma.Can a hematoma cause permanent damage? ›
If you have a subdural hematoma, your prognosis depends on your age, the severity of your head injury and how quickly you received treatment. About 50% of people with large acute hematomas survive, though permanent brain damage often occurs as a result of the injury.Which type of hematoma has the highest mortality rate? ›
Unilateral hematoma resulted in higher mortality rates compared to bilateral hematoma. In addition, getting old was related with decreased survival rates. However, the presence of comorbid diseases increased the duration of hospitalization but did not affect mortality.When is surgery needed for epidural hematoma? ›
Indications for surgery: An epidural hematoma (EDH) greater than 30 cm3 should be surgically evacuated regardless of the patient's Glasgow Coma Scale (GCS) score.Can epidural hematoma cause mass effect? ›
For epidural hematomas that are large, cause focal neurologic deficits, altered consciousness, or a mass effect, or are located in the temporal or posterior fossa, urgent removal by craniotomy is generally required. The outcome is usually good and strongly correlates with the clinical presentation.Can you feel the effects of traumatic brain injury years later? ›
You suffered a brain injury from a bump, blow, or jolt to the head earlier in your life. Years later, you experience one or many symptoms: foggy thinking, memory loss, trouble sleeping, anxiety, depression, or personality changes.Can you recover from Dai brain injury? ›
DAI is a serious but common type of traumatic brain injury. It can be fatal, but it is also possible to regain consciousness after a DAI. For those who recover, intensive rehabilitation will be needed.Does traumatic brain injury affect memory? ›
Memory problems are very common in people with moderate to severe TBI. TBI can damage parts of the brain that handle learning and remembering. TBI affects short-term memory more than long-term memory.Is traumatic brain injury a terminal illness? ›
Mild traumatic brain injury may affect your brain cells temporarily. More-serious traumatic brain injury can result in bruising, torn tissues, bleeding and other physical damage to the brain. These injuries can result in long-term complications or death.What are the three types of traumatic brain injury? ›
- Closed brain injury. Closed brain injuries happen when there is a nonpenetrating injury to the brain with no break in the skull. ...
- Penetrating brain injury. Penetrating, or open head injuries happen when there is a break in the skull, such as when a bullet pierces the brain.
Does traumatic brain injury change a person? ›
People who have a moderate or severe traumatic brain injury (TBI) may have changes in their behavior. People with a TBI and their families encounter some common behaviors: Problems managing emotions. People with a TBI may have a sudden change in mood; they also may have an extreme emotional response to a situation.What is the treatment for acute epidural hematoma? ›
In patients with acute and symptomatic EDHs, the treatment is craniotomy and hematoma evacuation. Based on the available literature, “trephination” (or burr hole evacuation) is often a crucial form of intervention if more advanced surgical expertise is unavailable; it may even decrease mortality.Can MRI detect epidural hematoma? ›
MRI can establish the presence, location and extent of the haematoma, along with cord compression and concurrent injuries. Epidural haematoma is the most common location of haematoma in the spine.What kind of blood accumulates in an epidural hematoma? ›
Epidural hematoma represents acute bleeding into the epidural space. This bleeding may be either arterial or venous. The classic epidural hematoma is observed with a linear skull fracture of the temporal bone, which tears the middle meningeal artery, allowing blood to accumulate under pressure in the epidural space.Can you recover from an epidural hematoma? ›
It is likely recovery from an epidural hematoma will take months or even years. In many cases, initial improvements happen within about 6 months after the injury. There are several steps a person can take at home to aid recovery.What is the difference in symptoms between epidural and subdural hematoma? ›
Patients with an epidural hematoma can remain conscious with minimal symptoms, can become drowsy, or can progress to a coma immediately following their injury based on the size of the hematoma. A subdural hematoma occurs when the bleeding exists inside the dura, but still outside the brain.What type of doctor drains a hematoma? ›
Doctors who typically care for patients with hematoma are emergency room physicians, urgent care physicians, surgeons, neurosurgeons, and internal medicine doctors.Can epidural cause neurological problems? ›
The needle or epidural tube can damage nerves, but this is uncommon. Nerve damage can cause loss of feeling or movement in parts of your lower body. The most common symptom is a small, numb area with normal movement and strength. This usually gets better after a few days or weeks, but can sometimes take months.Can epidural hematoma cause paralysis? ›
The symptoms of epidural hematoma result from compression of the spinal cord or nerve roots below the affected spinal level: neck or back pain and radicular pain, followed by more or less severe, but usually progressive, paralysis.How long can a hematoma go untreated? ›
Mild hematomas and contusions typically heal within about five days. A large hematoma may last weeks to months and as it heals it will change color and slowly shrink in size. Hematoma pain and swelling may be treated with over-the-counter (OTC) pain medications. Aspirin should not be used as it may increase bleeding.
How long is too long for a hematoma? ›
Watch closely for changes in your health, and be sure to contact your doctor or nurse advice line if: The bruise lasts longer than 4 weeks. The bruise gets bigger or becomes more painful. You do not get better as expected.What does a slow brain bleed feel like? ›
feeling drowsy and finding it difficult to keep your eyes open. speech problems, such as slurred speech. problems with your vision, such as double vision. paralysis (loss of movement) on one side of the body.How long does it take for a traumatic hematoma to heal? ›
Most bruises fade away within two weeks without treatment. More severe bruising and hematomas may last a month or longer.Is nerve damage considered a permanent injury? ›
Nerve damage can be extremely debilitating and could result in permanent disabilities. The impact of nerve damage could range from numbness to chronic pain or even paralysis.How do you tell if a nerve is permanently damaged? ›
The signs of nerve damage include the following: Numbness or tingling in the hands and feet. Feeling like you're wearing a tight glove or sock. Muscle weakness, especially in your arms or legs.Can you have a hematoma for years? ›
Some hematomas persist as slowly expanding, space-occupying masses for months or years, and are termed as chronic expanding hematomas (CEH) . In general, hematomas are naturally reabsorbed and rarely cause serious problems.What happens if a hematoma is left untreated? ›
If a haematoma is left untreated and the pressure within the haematoma exceeds the blood pressure in the dermal and subdermal capillaries, it may result in a large area of necrosis of the overlying skin. Therefore, an urgent evacuation of the haematoma must be performed to release the tension over the skin.What happens if a hematoma won't go away? ›
Common Signs & Symptoms
Most hematomas eventually dissolve, but in some cases they may continue to grow or show no change. If the lump stays or causes pressure on other structures (usually in the legs), then it may need to be surgically removed.
Brain and Skull Hematomas
The most dangerous and life-threatening hematomas are in the brain and skull. With these, the blood can become trapped within the skull and put pressure on the brain.
The mortality associated with acute subdural hematoma has been reported to range from 36-79%. Many survivors do not regain previous levels of functioning, especially after an acute subdural hematoma severe enough to require surgical drainage. Favorable outcome rates after acute subdural hematoma range from 14-40%.
Can a hematoma be fatal? ›
The bleeding is under the skull and outside the brain, not in the brain itself. As blood pools, however, it puts more pressure on the brain. The pressure on the brain causes symptoms. If pressure inside the skull rises to a very high level, a subdural hematoma can lead to unconsciousness and death.What are the long term effects of an epidural hematoma? ›
Other complications include permanent symptoms, such as: Herniation of the brain and permanent coma. Normal pressure hydrocephalus, which can lead to weakness, headaches, incontinence, and difficulty walking. Paralysis or loss of sensation (which began at the time of the injury)Can a hematoma cause muscle damage? ›
Muscle hematomas can have a significant impact on an athlete's performance, ranging from short-term performance impairment, muscle deconditioning and compartmental syndromes, to long-term problems, such as myositis ossificans and possibly muscle re-injuries.What body system does a hematoma affect? ›
A hematoma is a collection of blood outside the blood vessels that causes pain and swelling, and disfiguring bruises. Some hematomas can affect internal organs, damage your skin and tissue, and be severe enough to require medical attention.What falls under traumatic brain injury? ›
Traumatic brain injury usually results from a violent blow or jolt to the head or body. An object that goes through brain tissue, such as a bullet or shattered piece of skull, also can cause traumatic brain injury. Mild traumatic brain injury may affect your brain cells temporarily.Is a brain bleed considered a TBI? ›
Bleeding in the brain is a common result of moderate or severe traumatic brain injury (TBI). As blood pools under the injury, pressure on the brain increases, resulting in a loss of oxygen to the brain.Is a hemorrhage a traumatic brain injury? ›
TBI encompasses numerous types of insults to the brain, with one of the most severe being a hemorrhagic cerebral contusion. TBI associated with cerebral contusion is a frequent cause of death and disability in trauma victims who reach the hospital alive (Alahmadi et al., 2010).How do you prove traumatic brain injury? ›
A traumatic-brain injury diagnosis is based on one or more of the following criteria: loss of consciousness, memory loss for events immediately before or after the injury, confusion and disorientation, and neurologic signs such as a wound to the skull, seizures, or headache.What does traumatic brain injury do to the brain? ›
Primary effects on the brain include various types of bleeding and tearing forces that injure nerve fibers and cause inflammation, metabolic changes, and brain swelling. Diffuse axonal injury (DAI), one of the most common types of brain injuries, refers to widespread damage to the brain's white matter.What are some common disabilities as a result of TBI? ›
- depressive temperament.
- socialisation problems.
How long does it take to recover from severe traumatic brain injury? ›
In fact, depending on the severity of the injury, recovery time for a TBI may vary from a few weeks to six or more months. Each person reacts differently to injury and illness. Thus, recovery time will vary between individuals. However, the length of recovery time for TBI depends on how long a patient is unconscious.Does the brain heal after a brain bleed? ›
Recovery after an intracranial hematoma can take a long time, and you might not recover completely. The greatest period of recovery is up to three months after the injury, usually with lesser improvement after that.What are the long-term effects of a traumatic brain injury? ›
Anxiety and depression are common. Personality (mood) changes, mood swings, and difficulty controlling impulses can also be an issue. The challenges associated with life after a TBI and the emotional and personality changes that sometimes go along with it can also contribute to relationship difficulties.What are the chances of surviving a brain bleed from trauma? ›
Bleeding in the brain or brain hemorrhage can be life-threatening, with an estimated 5-year survival rate of about 26.7%.Is traumatic brain injury serious? ›
A traumatic brain injury, or TBI, is an injury that affects how the brain works. TBI is a major cause of death and disability in the United States. Anyone can experience a TBI, but data suggest that some groups are at greater risk for getting a TBI or having worse health outcomes after the injury.What is the most common type of traumatic brain injury? ›
Concussion is among the most common forms of TBI. A concussion can happen when the head or body is moved back and forth quickly, such as during a car crash or sports injury, or from a blow to the head. Concussions are often called “mild TBIs,” because they are usually not life-threatening.What is the most common traumatic brain injury? ›
People most commonly get TBIs from a fall, firearm-related injury, motor vehicle crash, or an assault. Research shows that: Falls lead to nearly half of the TBI-related hospitalizations. Firearm-related suicide is the most common cause of TBI-related deaths in the United States.