[Ipsilateral exophthalmos in chronic extradural fluid-hematoma, case report (author's transl)]

A case of chronic extradural hematoma with liquid contents that had showed ipsilateral exophthalmos was reported. A 10-year-old girl fell and struck on her head. Neurological examination, on admission to our hospital on tenth day after the injury, revealed left exophthalmos and slight right hemiparesis. Plain craniogram showed linear fractures of frontal bone and orbital roof on left side. Left carotid angiogram and computerized tomogram revealed a huge extradural hematoma with liquid contents in the left frontal region. Extirpation of the hematoma was performed on the twenty-third day after the injury. When a burr hole was drilled on the left frontal region, there was no capsule of the hematoma and contents of the hematoma was dark brownish fluid. The source of bleeding in our case was considered to be the diploic vein. The blow to the head at the time of the injury distorted the skull and separated the dura from the bone. The venous bleeding developed in the space thus formed, and a small hematoma was produced. The small hematoma might have enlarged by a process similar to that postulated in chronic subdural hematoma. Thus a huge extradural hematoma with liquid contents might have been produced. There may be two factors as causes of exophthalmos. 1) Blood from the frontal extradural hematoma through the fracture of orbital roof into the orbit is postulated to have compressed the periorbita. 2) Direct pressure by the frontal hematoma on the cavernous sinus and the superior ophthalmic vein produced venous circulatory disturbance of the orbit and was postulated to have caused the ipsilateral exophthalmos.