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Vertex epidural hematomas: imaging findings and diagnostic pitfalls
O L Harbury1, J M Provenzale, D P Barboriak
1Metrolina Imaging Group, Mercy Hospital, Charlotte, NC 28207, USA.
European Journal of Radiology
|November 25, 2000
Summary
Vertex epidural hematomas (EDHs) can be challenging to diagnose with computed tomography (CT). Magnetic resonance (MR) imaging or thin-section CT is recommended for accurate diagnosis in skull vertex trauma cases.
Area of Science:
- Neuroradiology
- Medical Imaging
- Neurology
Background:
- Epidural hematomas (EDHs) are collections of blood between the dura mater and the skull.
- Vertex EDHs, located at the top of the skull, present unique diagnostic challenges.
Purpose of the Study:
- To illustrate the computed tomography (CT) and magnetic resonance (MR) imaging characteristics of vertex epidural hematomas (EDHs).
- To highlight diagnostic pitfalls associated with identifying vertex EDHs.
Main Methods:
- Retrospective review of neuroradiologic studies (CT, MR imaging, MR venography) in four patients with vertex EDHs.
- Evaluation of EDH shape, size, and imaging appearance.
Main Results:
- EDHs exhibited biconvex (3 patients) or crescentic (1 patient) shapes.
- CT findings varied from hyperdense to mixed hyperdense/hypodense.
- MR imaging showed specific signal intensities.
- Inferior displacement of the superior sagittal sinus was observed in two patients.
- A small vertex EDH was difficult to detect on routine axial CT but clear on MR imaging and MR venography.
Conclusions:
- Small vertex EDHs pose diagnostic difficulties on standard CT scans.
- MR imaging or thin-section CT is crucial for excluding vertex EDHs in patients with skull vertex trauma.