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Chronic extradural haematoma with delayed expansion
K S Manjunath-Prasad1, S K Gupta, V K Khosla
1Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
British Journal of Neurosurgery
|February 1, 1997
Summary
Delayed symptoms from chronic extradural haematoma (EDH) can occur. A surrounding membrane with neovascularisation suggests EDH is not cured until both membrane and haematoma resolve on CT scans.
Area of Science:
- Neurosurgery
- Radiology
- Pathology
Background:
- Extradural haematomas (EDH) are collections of blood between the dura mater and the skull.
- Chronic EDH typically present with delayed neurological symptoms, often weeks to months after head trauma.
- Neovascularisation within the EDH membrane can contribute to delayed expansion and symptom onset.
Observation:
- A 35-year-old male presented with symptoms 26 months post-head injury.
- CT imaging revealed an occipital-suboccipital chronic EDH with a surrounding membrane.
- The membrane exhibited neovascularisation, confirmed on both CT and during surgical exploration.
Findings:
- The unusually long interval (26 months) between head injury and symptom presentation is highlighted.
- Delayed expansion of a chronic EDH, potentially due to neovascularisation, is suggested as a cause for late-onset symptoms.
- The presence of a neovascularised membrane indicates ongoing pathological processes within the chronic EDH.
Implications:
- Conservative management of chronic EDH requires careful consideration of potential delayed expansion.
- Radiological monitoring with CT is crucial for assessing the resolution of both the haematoma and its surrounding membrane.
- A chronic EDH should only be considered resolved ('cured') upon complete disappearance of the membrane and haematoma on CT imaging.