Spontaneous bilateral epidural hematomas caused by chronic sinusitis: illustrative case

Spontaneous bilateral epidural hematomas (EDHs) are rare. The aim of this study was to report a 21-year-old male with spontaneous bilateral EDHs to discuss the pathogenesis of spontaneous bilateral EDHs caused by chronic sinusitis.

A 21-year-old male with no history of head trauma was admitted to the hospital for headache and unconsciousness. The patient had bilateral nasal bleeding on the day before admission and had chronic sinusitis since childhood. The head computed tomography examination after admission showed bilateral EDHs and bilateral sinusitis, the head magnetic resonance imaging showed chronic sinusitis, and the endoscopic examination during surgery further confirmed that the patient had severe sinusitis with erosion of the bilateral nasal mucosae. The patient underwent emergent surgical treatment. The cerebral vascular malformation, autoimmune diseases, low intracranial pressure, blood system diseases (such as sickle cell disease), abnormal blood coagulation, and skull or meningeal lesions were all excluded after operation.

Chronic sinusitis may lead to EDHs through causing vascular degeneration, and abruption of the dura mater and skull. For young patients with spontaneous EDHs, neurosurgeons should carefully ask patients whether they have a history of chronic sinusitis to exclude the possibility of bleeding caused by chronic sinusitis.