Conservative Management of Large Vertex Extradural Hematoma: A Case Report

Abstract

Vertex extradural hematomas may be missed when axial section brain computed tomographic scans are used alone for diagnosis. Conservative treatment may be preferred in such patients when actualized the essential conditions. A 24-year-old mentally retarded male patient was admitted to the emergency department with a history of falling from the same level and head trauma. Neurological examination and axial cross-sectional brain computed tomography performed in the emergency room were evaluated as normal, and the patient was discharged. Vertex extradural hematoma adjacent to the bone fracture was diagnosed with axial, coronal and sagittal reconstructed brain computerized tomography sections of the patient who came back with headache complaint 2 days later. Despite the difficulties in neurological examination due to mental retardation, surgical treatment was not planned with very close neurological examination. The patient was followed up in the neurosurgery intensive care unit for 2 days and in the neurosurgery service for 7 days. He was discharged because there was no abnormality in his neurological follow-ups and no increase in hematoma size. In the first outpatient follow-up, one month later, the hematoma was completely resorbed. The patient was treated conservatively with close conscious and neurological examination follow-up. In order not to miss vertex extradural hematomas in the brain computed tomography performed in patients presenting to the emergency department with head trauma, coronal and sagittal sections should be reconstructed in addition to axial sections. Conservative treatment can be preferred if vertex extradural hematomas are neurological examined closely, no motor deficits and there is no increase in hematoma size in control imaging.

Keywords

• Extradural hematoma
• conservative treatment
• trauma
• vertex

Büyük Verteks Ekstradural Hematomun Konservatif Yönetimi: Bir Olgu Sunumu

Abstract

Aksiyal kesitli beyin bilgisayarlı tomografi taramaları tanı için tek başına kullanıldığında Verteks ekstradural hematomlar atlanabilir. Bu hastalarda gerekli koşullar sağlandığında konservatif tedavi tercih edilebilir. 24 yaşında mental retarde erkek hasta aynı seviyeden düşme ve kafa travması ile acil servise başvurdu. Acil serviste yapılan nörolojik muayene ve aksiyel kesitsel beyin bilgisayarlı tomografisi normal olarak değerlendirilerek hasta taburcu edildi. 2 gün sonra baş ağrısı şikayeti ile başvuran hastanın aksiyel, koronal ve sagital rekonstrükte beyin bilgisayarlı tomografi kesitlerinde kemik kırığı komşuluğunda verteks ekstradural hematom tanısı kondu. Mental retardasyon nedeniyle nörolojik muayenede yaşanan zorluklara rağmen çok yakın nörolojik muayene ile cerrahi tedavi planlanmadı. Hasta 2 gün beyin cerrahisi yoğun bakım ünitesinde, 7 gün beyin cerrahi servisinde izlendi. Nörolojik takiplerinde anormallik olmaması ve hematom boyutunda artış olmaması üzerine taburcu edildi. Bir ay sonraki ilk poliklinik takibinde hematom tamamen rezorbe olmuştu. Hasta yakın bilinç ve nörolojik muayene takibi ile konservatif olarak tedavi edildi. Acil servise kafa travması ile başvuran hastalarda yapılan beyin bilgisayarlı tomografisinde verteks ekstradural hematomların atlanmaması için aksiyal kesitlere ek olarak koronal ve sagittal kesitlerin rekonstrüksiyonu yapılmalıdır. Verteks ekstradural hematomlar nörolojik olarak yakından incelendiği, motor defisit olmadığı ve kontrol görüntülemede hematom boyutunda artış olmadığı sürece konservatif tedavi tercih edilebilir.

Keywords

• Ekstradural hematom
• konservatif tedavi
• travma
• verteks

References

1. Su TM, Lin CC, Lan CM, Lee TH, Hsu SW, Lu CH. Vertex epidural hematoma: Diagnosis, therapeutic consideration and outcome. Injury. January 2023;54(1):87-92.
2. Ben-Israel D, Isaacs AM, Morrish W, Gallagher NC. Acute vertex epidural hematoma. Surg Neurol Int. 2017;8:219.
3. Ramesh VG, Kodeeswaran M, Deiveegan K, Sundar V, Sriram K. Vertex epidural hematoma: An analysis of a large series. Asian J Neurosurg. 2017;12(2):167-71.
4. Navarro JN, Alves RV. Vertex epidural hematoma: A rare cause of post-traumatic headache and a diagnostic challenge. Surg Neurol Int. 2016;7(Suppl 10):S276-278.
5. Klepinowski T, Kawalec P, Larysz M, Sagan L. Acute-on-Chronic Vertex Epidural Hematoma with Diastasis of the Sagittal Suture in an Adult. World Neurosurg. July 2020;139:245-9.
6. Kim JH, Yoon WK, Kwon TH, Kim JH. Clinical features and treatment strategies for vertex epidural hematoma: a systematic review and meta-analysis from individual participant data. Neurosurg Rev. February 2022;45(1):819-30.
7. Kotani S, Murakami N, Doi T, Ogawa T, Hashimoto N. Acute epidural vertex hematoma with good hemostasis using delayed surgery after monitoring of coagulation and fibrinolytic parameters: A case report. Surg Neurol Int. 2023;14:73.
8. Champeaux C, Lainé G, Gimbert E, Jecko V. Successful conservative management of large vertex epidural hematoma. Neurochirurgie. December 2019;65(6):438-9.

9. Bonilha L, Mattos JPV, Borges WAA, Fernandes YB, Andrioli MSD, Borges G. Chronic epidural hematoma of the vertex. Clin Neurol Neurosurg. December 2003;106(1):69-73.
10. Chauvet D, Reina V, Clarencon F, Bitar A, Cornu P. Conservative management of a large occipital extradural haematoma. Br J Neurosurg. August 2013;27(4):526-8.