Skip to main content
Log in

Delayed post-traumatic epidural hematoma. A review

  • Original Articles
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Post-traumatic acute epidural hematoma (EDH) is generally visible on the CT scan done immediately after admission: occasionally, it only comes to light at a later scan and is then termed delayed (DEDH). Since the introduction of CT, the frequency of this occurrence has gone up from 6–13% to 30%.

The mechanisms responsible for the delayed appearance of the epidural hematoma a “tamponade” effect are usually increased endocranial pressure and post-traumatic arterial hypotension as well as, in a limited number of cases, coagulopathy, CSF drainage, and arterio-venous shunt.

The authors report 5 of their own cases and 45 published cases and discuss the characteristics of this particular form of hematoma and its outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ashekanzi E, S Constantini, S Pomeranz, AL Rivkind, ZH Rappaport: Delayed epidural hematoma without neurologic deficit. J Trauma 1990 Ma 30 (1990) 613–615

    Google Scholar 

  2. Borovich B, J Braun, NJ Guilburd, M Zaaroor, M Michich, L Levy, A Lemberger, I Gruszkiewicz, M Feinsod, I Schachter: Delayed onset of traumatic extradural hematoma. J Neurosurg 63 (1985) 30–34

    Google Scholar 

  3. Bricolo AP, LM Pasut: Extradural hematoma: toward zero mortality. A prospective study. Neurosurgery 14 (1984) 8–12

    Google Scholar 

  4. Bucci MN, TW Phillips, JE McGillicuddy: Delayed epidural hemorrhage in hypotensive multiple trauma patients. Neurosurgery 19 (1986) 65–68

    Google Scholar 

  5. Bullock R, G Taesdale: Surgical management of traumatic intracranial haemotomas. In: Vinken PJ, GW Bruyn (eds): Handbook of Clinical Neurology, Vol. 13 (57): Head Injury. Elsevier Science Publishers B. V., Amsterdam 1990

    Google Scholar 

  6. Bullock R, JR Van Dellen: Chronic extradural hematoma. Surg Neurol 18 (1982) 300–302

    Google Scholar 

  7. Campbell JB, J Cohen: Epidural hemorrhage and the skull of children. Surg-Gynec-Obstet 92 (1951) 257–280

    Google Scholar 

  8. Cervantes LA: Concurrent delayed temporal and posterior fossa epidural hematomas. Case report. J Neurosurg 59 (1983) 351–353

    Google Scholar 

  9. Chan KH, KS Mann, CP Yue, YW Fan, M Cheung: The significance of skull fracture in acute traumatic intracranial hematomas in aldolescents: a prospective study. J Neurosurg 72 (1990) 189–194

    Google Scholar 

  10. Di Rocco A, SJ Ellis, C Landes: Delayed epidural hematoma. Neuroradiology 33 (1991) 253–254

    Google Scholar 

  11. Ericsson K, S Hakanson, J Lofgren, NN Zwetnow: Arteriovenous shunting — a basic pathophysiological mechanism in epidural haematoma. Acta neurochir (Wien) 42 (1978) 257–258

    Google Scholar 

  12. Fankhauser H, M Kierner: Delayed development of extradural haematomas. Acta Neurochir 60 (1982) 29–35

    Google Scholar 

  13. Fankhauser H, A Uske, N de Tribolet: Delayed epidural hematoma. Apropos of a series of 8 cases. Neurochirurgie 29 (1983) 255–260

    Google Scholar 

  14. Feuerman T, PA Wackym, GF Gade, D Becker: Value of skull radiography, head computed tomographic scanning and admission for observation in cases of minor head injury. Neurosurgery 22 (1988) 449–453

    Google Scholar 

  15. Feuerman T, PA Wackym, GF Gade, T Lanman, D Becker: Intraoperative development of contralateral epidural hematoma during evacuation of traumatic extraaxial hematoma. Neurosurgery 23 (1988) 480–484

    Google Scholar 

  16. Flores JS, J Vaquero, RG Sola, E Rossi, R Martinez, P Martinez, H Santos, G Bravo: Traumatic false aneurisms of the middle meningeal artery Neurosurgery 18 (1986) 200–202

    Google Scholar 

  17. Ford LE, RL McLaurin: Mechanisms of extradural hematomas. J Neurosurg 20 (1963) 760–769

    Google Scholar 

  18. Fukamachi A, S Misumi, M Kaneko, T Wakao: Traumatic extradural hematomas with delayed development. Computeraized Radiol 8 (1984) 197–201

    Google Scholar 

  19. Gallanger JP, EJ Browder: Extradural hematoma. Experience with 167 patients. J Neurosurg 29 (1968) 1–12

    Google Scholar 

  20. Goodkin R, J Zahniser: Sequential angiographic studies demonstrating delayed development of an acute epidural hematoma. J Neurosurg 48 (1978) 479–482

    Google Scholar 

  21. Gruszkiewicz J, Y Doron, E Peyser: Frontal extradural hematomas. Surg-Neurol 5 (1976) 122–128

    Google Scholar 

  22. Gurdjian ES, HR Lissner: Deformations of the skull in the head injury as studied by the “stresscoat” technic. Amer-J-Surg 73 (1947) 269–280

    Google Scholar 

  23. Habash AH, O Sortland, NN Zwetnow: Epidural haematoma: pathophysiological significance of extravasation and arteriovenous shunting. An analysis of 35 patients. Acta neurochir (Wien) 60 (1982) 7–27

    Google Scholar 

  24. Hakanson S, J Lofgren, NN Zwetnow The intracranial pressure course in experimental epidural haemorrhage. Acta neurochir (Wien) 37 (1977) 294–295

    Google Scholar 

  25. Hooper R: Observations on extradural haemorrhage. Br-J-Surg 47 (1959) 71–87

    Google Scholar 

  26. Iuvara-Bommeli A, N de Tribolet: Delayed intracranial hematomas following cranio-cerebral trauma. Schweiz-Med-Wochenschr 121 (1991) 646–652

    Google Scholar 

  27. Iwakuma T, CV Brunngraber: Chronic extradural hematomas: A study of 21 cases. J Neurosurg 38 (1973) 488–493

    Google Scholar 

  28. Jamieson KG, DN Yelland: Extradural hematoma. Report of 167 cases. J Neurosurg 29 (1968) 13–23

    Google Scholar 

  29. Koulouris S, HV Rizzoli: Acute bilateral extradural hematoma: case report. Neurosurgery 7 (1980) 608–610

    Google Scholar 

  30. Lofgren J, NN Zwetnow: Tolerance of the brain for a rapidly expanding supratentorial mass. An experimental study on cats. Acta neurol scand 46 (1970) 625

    Google Scholar 

  31. Maliszewski M, H Majchrzak, G Bierzynska-Macyszyn, A Lech: Podostry krwiak nadtwardkowkowy (Subacute epidural hematoma). Neur Neurochir Pol 25 (1991) 756–761

    Google Scholar 

  32. Meguro K, E Kobayashi, Y Maki: Acute brain swelling during evacuation of subdural hematoma caused by delayed contralateral extradural hematoma: report of two cases. Neurosurgery 20 (1987) 326–328

    Google Scholar 

  33. Milo R, N Razon, J Schiffer: Delayed epidural hematoma. A review. Acta-Neurochir-(Wien) 84 (1987) 13–23

    Google Scholar 

  34. Nicola N, U Dietrich, HK Seibert: Value of computeraized tomography in setting the indication for surgical treatment of extradural hematomas with a delayed course. Acta-Neurochir-(Wien) 56 (1981) 225

    Google Scholar 

  35. Piepmeier J; FC Wagner: Delayed post-traumatic extracerebral hematomas. J Trauma 1982 Jun 22 (1982) 455–460

  36. Poon WS, SU Rehman, CYF Poon, AKC Li: Traumatic extradural hematoma of delayed onset is not a rarity. Neurosurgery 30 (1992) 681–686

    Google Scholar 

  37. Pozzati E, F Frank, G Frank, G Gaist: Subacute and chronic extradural hematomas: a study of 30 cases. J Trauma 20 (1980) 795–799

    Google Scholar 

  38. Rappaport ZH, I Shaked, R Tadmor: Delayed epidural hematoma demonstrated by computed tomography: case report Neurosurgery 10 (1982) 487–489

    Google Scholar 

  39. Reale F, R Biancotti: Acute bilateral epidural hematoma. Surg Neurol 24 (1985) 260–262

    Google Scholar 

  40. Reale F, R Delfini, G Mencattini: Epidural hematomas. J Neurosurg Sci 28 (1984) 9–16

    Google Scholar 

  41. Rivas JJ, RD Lobato, R Sarabia, F Cordobes, A Cabrera, P Gomez: Extradural hematoma: Analysis of factors influencing the courses of 161 patients. Neurosurgery 23 (1988) 44–51

    Google Scholar 

  42. Sakai H, H Takagi, H Ohtaka, T Tanabe, T Ohwada, K Yada: Serial changes in acute extradural hematoma size and associated changes in level of consciousness and intracranial pressure. J Neurosurg 68 (1988) 566–570

    Google Scholar 

  43. Sautreaux JL, MC Lopin, A Thierry, T Tracard, R Cobtane: Lès hématomas extra-duraux multiples et récidivants. Agressologie 30 (1989) 293–294

    Google Scholar 

  44. Schechter MM, LH Zingesser, M Rayport: Torn meningeal vessels: An evaluation of a clinical spectrum through the use of angiography. Radiology 86 (1966) 686–695

    Google Scholar 

  45. Smith HK, JD Miller: The danger of an ultraearly computed tomographic scan in a patient with an evolving acute epidural hematoma. Neurosugery 29 (1991)258–260

    Google Scholar 

  46. Snyder HS, D Salo: Epidural hematoma: an unusual presentation. Am-J-Emerg-Med 8 (1990) 538–541

    Google Scholar 

  47. Sparacio RR, R Khatib, J Chiu, AW Cook: Chronic epidural hematomas. J Trauma 12 (1972) 435–439

    Google Scholar 

  48. Stein SC, GS Young, RC Talucci, BH Greenbaum, SE Ross: Delayed brain injury outlook of severe head injury. Acta-Neurochir-(Wien) 85 (1987) 87–95

    Google Scholar 

  49. Turazzi S, A Bricolo, ML Pasut, A Formenton: Changes produced by CT scanning in the outlook of severe head injury. Acta neurochir (Wien) 85 (1987) 87–95

    Google Scholar 

  50. Viljoen JJ, LS Wessels: Subacute and extradural haematomas. S-Afr-J-Surg 28 (1990) 133–137

    Google Scholar 

  51. Zuccarello M, DL Fiore, K Pardatscher, G Trincia, GC Andrioli: Chronic extradural haematomas. Acta-Neurochir-(Wien) 67 (1983) 57–66

    Google Scholar 

  52. Zwetnow NN, AN Habash, J Loftgren, S Hakanson. Comparative analysis of experimental epidural and subarachnoid bleedings in dogs. Acta neurochir (Wien) 67 (1983) 67–101

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Domenicucci, M., Signorini, P., Strzelecki, J. et al. Delayed post-traumatic epidural hematoma. A review. Neurosurg. Rev. 18, 109–122 (1995). https://doi.org/10.1007/BF00417668

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00417668

Keywords

Navigation