1/16. Sickle cell disease with orbital infarction and epidural hematoma.Although bone infarction is a common feature in sickle cell disease, the involvement of the orbit is an unusual complication. Intracranial bleeding is another uncommon and serious complication. Few cases of orbital infarction alone have been reported. We report imaging findings (CT, bone scan, MRI) in a 16-year-old boy with sickle cell disease with orbital infarction and epidural hematoma. The precise cause of epidural hematoma is not well known, but it is probably related to vaso-occlusive episodes and the tearing of small vessels.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/16. The injured coach.The patient in this case was diagnosed as having an epidural hematoma (shown in x-ray at right). This results from hemorrhage between the dura mater and the skull. The hemorrhage may result from a traumatic insult to the side of the head, which can fracture the temporal bone and lacerate the middle meningeal artery. Since the hemorrhage is arterial in nature, the patient may deteriorate quickly. These patients may present with what is referred to as a "lucid interval." The patient typically has a significant blow to the head that results in a short period of unconsciousness. They then regain consciousness at a time that frequently coincides with the arrival of EMS. Once conscious, they are in a period known as the lucid interval. They will still have a headache, but may otherwise be acting normally and show no other physical findings on examination. Many such patients refuse treatment and transport. [table: see text] Inside the skull, however, the problem will grow. Broken arterial vessels are bleeding, causing an expanding hematoma. The patient typically will soon complain of a severe headache along with other associated complaints, such as nausea/vomiting, then will lose consciousness again and/or have a seizure. Initial physical findings may include contralateral weakness and a decreased Glasgow coma score. As the hematoma expands, cerebral herniation may occur, compressing the third cranial nerve, which presents as a "blown pupil." EMS providers should have a high suspicion of injuries that affect the side of the head and the base of the skull. It is important to not only assess such injuries, but also the mechanism of injury, and to know the complications or later presentation that can arise from such injuries. Given that this patient was alert, oriented, not obviously intoxicated, and accompanied by his wife, the providers in this case would have had no choice but to abide by a refusal of treatment and transport. However, that could lead to serious complications, such as ongoing minor neurological deficits, later on. If this is the case, contacting medical control should be the priority.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/16. Extensive spinal epidural hematoma: a rare complication of aortic coarctation.Development of collateral circulation belongs among the typical signs of aortic coarctation. Cerebral or spinal artery aneurysm formation with increased risk of subarachnoid hemorrhage represent the most common neurovascular complication of this disease. We report a case of a 20-year-old sportsman who developed acute non-traumatic paraplegia as a result of extensive spinal epidural hemorrhage from collateral vessels accompanying aortic coarctation which was unrecognized up to that time. To the best of our knowledge, acute spinal epidural hematoma as a complication of aortic coarctation has not been previously reported.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/16. Epidural hematomas in a child with Hutchinson-Gilford progeria syndrome.INTRODUCTION. Hutchinson-Gilford progeria syndrome (HGPS) is a rare genetic disorder. It is characterized by severe growth failure, premature aging, and very early atherosclerosis with coronary artery disease and cerebrovascular disease. CASE REPORT. A 10-year-old boy with HGPS was admitted to our department because of progressive deterioration after a mild head injury. The CT scans revealed epidural hematoma in posterior fossa and another one in the temporal region on the left side. On admission the child was given an estimated score of 10 on the GCS. Neurological examination revealed right hemiparesis. The boy was operated on, and both hematomas were evacuated. In a few days the neurological symptoms disappeared, and he was discharged from the hospital with only residual, minimal right hemiparesis. CONCLUSION. Intracranial pathology was certainly caused by the head trauma, but was more severe than would have been expected had the trauma been the sole cause. We suggest that progressive atherosclerosis of intracranial vessels was responsible for formation of the hematomas.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/16. Symptomatic hematoma of lumbar facet joint: joint apoplexy of the spine?STUDY DESIGN: A case report. OBJECTIVES: To report and discuss a rare case of epidural hematoma that was considered to be formed as a result of idiopathic bleeding occurring at the facet joint (joint apoplexy). SUMMARY OF THE BACKGROUND DATA: Spontaneous spinal epidural hematoma is a relatively rare condition. According to a review article of 199 spontaneous spinal epidural hematomas in the last 2 decades, the majority of these conditions are thought to result from a rupture of the epidural vascular network. Recently, a hemorrhagic lumbar synovial cyst and a hematoma occurring from the ligamentum flavum were reported as rare types of epidural hematoma. methods: The authors describe the treatment and the clinical, radiologic, surgical, and pathologic findings in one patient with a rare epidural hematoma. RESULTS: magnetic resonance imaging revealed that the extradural mass lesion was continuous with the right L4-5 facet joint; this was confirmed by surgery when the extradural hematoma was directly visualized. The joint cavity was also filled with the hematoma. There was no evidence of preceding cyst formation macroscopically or microscopically. The excised capsule of the left L4-5 facet joint revealed moderate hyperplasia of the synovium with an increased number of capillary vessels. CONCLUSIONS: This is the first reported case of radiculopathy considered to be a result of facet joint apoplexy in the absence of any preceding synovial cyst formation. The pathomechanism of the hemorrhage at the lumbar facet joint is unclear, but it is speculated that there could be an association with degenerative change of the facet joint. Surgical excision of this mass was considered to be the definitive treatment.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/16. Spontaneous epidural hematoma from a hepatocellular carcinoma metastasis to the skull--case report.A rare case of acute epidural hematoma originating from a hepatocellular carcinoma metastasis to the skull in a 52-year-old male is reported. The skull metastasis and epidural hematoma were completely removed, but he died of large liver tumor. Histological examination of the removed tumor showed many sinusoid-like blood vessels, which probably lead to hemorrhage and formation of epidural hematoma.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/16. Traumatic dissection of the internal maxillary artery associated with isolated glossopharyngeal nerve palsy: case report.OBJECTIVE AND IMPORTANCE: Spontaneous or traumatic dissection of the internal carotid artery with resultant lower cranial nerve palsies is well documented. However, dissection of the external carotid artery with lower cranial palsies has not been reported previously. CLINICAL PRESENTATION: A 42-year-old man experienced an epidural hematoma as the result of a fall and underwent a craniotomy and hematoma removal. Subsequently, he developed dysgeusia and difficulty in swallowing. brain magnetic resonance imaging showed a dilated linear structure, with isosignal intensity on T1-weighted images and hyperintense signal intensity on T2-weighted images. Strong enhancement was seen on postcontrast T1-weighted images, indicating a dissected internal maxillary artery. This was confirmed on selective angiography of the left common carotid artery. INTERVENTION: Guglielmi detachable coils were introduced into the false lumen of the dissected artery. Subsequently, 0.5 ml of glue mixed with Lipiodol (Lafayette Pharmacal, Lafayette, IN) was packed into the remnant of the false lumen. Repeat angiograms demonstrated complete occlusion of the dissected vessel. The patient's postoperative course was uneventful, and the neurological deficits gradually improved. CONCLUSION: We describe the first reported case of internal maxillary artery dissection and pseudoaneurysm presenting with isolated glossopharyngeal nerve palsy. The association between cranial nerve palsy and dissection of the external carotid artery branch may be the result of a compressive mechanism, as suggested by its anatomic relationships, the characteristics of the dissection, and the good prognosis. Endovascular embolization of the external carotid artery dissection and pseudoaneurysm is suggested as an effective therapeutic method for improving or alleviating neurological deficits produced by mass effect.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/16. Extradural hematoma associated with traumatic middle meningeal artery pseudoaneurysm: report of two cases.Two new cases of extradural hematoma associated with traumatic middle meningeal artery pseudoaneurysm are presented. Sixteen such cases have previously been reported in the literature. A 22-year-old man and a 17-year-old woman each developed marked neurological deficits after head injury. In each case percutaneous common carotid angiography demonstrated a conspicuous aneurysmatic sac on the middle meningeal artery, as well as displacement of major intracranial vessels and a surrounding avascular area. At operation the extradural clot was removed and the middle meningeal artery sac was verified. Both patients recovered uneventfully. Histological analysis of one of the specimens was performed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/16. Delayed traumatic intracerebral hematomas after surgical decompression.Delayed traumatic intracerebral hematomas found after an initially unrevealing computerized tomographic scan have been reported occasionally. Such hemorrhage may occur in an area of brain contusion with cerebral vessel injury. Four cases of intracerebral hematoma appearing after evacuation of a different traumatic intracranial mass lesion are reported. This suggests that an intracranial mass lesion may tamponade cerebral venous oozing in an area of brain contusion and delay the accumulation of intracerebral blood, accounting for the late discovery of a parenchymal hematoma. (neurosurgery, 5: 653--655, 1979).- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/16. Chronic epidural haematoma. A non-typical course of extradural haemorrhage.4 patients with chronic epidural haematoma are presented. Emphasis is placed a) clinically on symptoms of an intracranial hypertension and b) on the C.T.-scan demonstrating the presence of a homogeneous clot. At operation the findings were a clotted haematoma encapsulated on the dural side and the still leaking blood vessel.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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