Spontaneous bilateral epidural hematomas caused by chronic sinusitis: illustrative case

Area of Science:

• Neurology
• Otolaryngology
• Radiology

Background:

• Spontaneous bilateral epidural hematomas (EDHs) are exceptionally rare occurrences.
• Chronic sinusitis is a common condition, but its association with EDHs is not widely recognized.

Purpose of the Study:

• To report a unique case of spontaneous bilateral EDHs in a 21-year-old male.
• To explore the potential pathogenesis of EDHs secondary to chronic sinusitis.

Main Methods:

• A comprehensive medical history, neurological examination, and advanced imaging (CT, MRI) were performed.
• Diagnostic evaluations excluded other common causes of spontaneous bleeding, including vascular malformations and coagulation disorders.
• Endoscopic examination confirmed severe chronic sinusitis with nasal mucosal erosion.

Main Results:

• The patient presented with headache, unconsciousness, and bilateral nasal bleeding.
• Imaging revealed bilateral EDHs and severe chronic sinusitis.
• Surgical intervention was performed, and other potential causes of bleeding were ruled out.

Conclusions:

• Chronic sinusitis may contribute to EDHs through vascular degeneration and dural/skull changes.
• Neurosurgeons should consider chronic sinusitis in young patients presenting with spontaneous EDHs.
• Thorough patient history, including sinus issues, is crucial for accurate diagnosis and management.