J Korean Neurotraumatol Soc.  2010 Jun;6(1):66-69. 10.13004/jknts.2010.6.1.66.

The Multifocal Cerebral Infarctions in Patient after Epidural Hematoma Evacuation

• Son JH
• Shin IY
• Chung YG
• Park KJ

• KMID: 2192371
• DOI: http://doi.org/10.13004/jknts.2010.6.1.66

Abstract

We report a patient who developed multiple focal cerebral infarctions after epidural hematoma evacuation. A 41-year-old man presented with altered mentality after sustaining a head trauma. Computer tomography (CT) scan showed large epidural hematoma at the left hemisphere. The patient underwent emergency evacuation of the hematoma and decompression surgery. Three days after the surgery, the patient showed right side hemiparesis. CT and MR diffusion weight images (MRDWI) revealed multiple infarctions at focal posterior cerebral artery (PCA) and middle cerebral artery (MCA) territories and subcortical parenchyma. Several months after the surgery, the patient showed improved mentality, but his cognition and hemiparesis were not improved as much. Before ischemic change occurs, it is vital to administer early, rapid and aggressive management are required to prevent posttraumatic cerebral infarction.

Keyword

Cerebral infarction; Head trauma; Epidural hematoma

MeSH Terms

Cerebral Infarction
Cognition
Craniocerebral Trauma
Decompression
Diffusion
Emergencies
Hematoma
Humans
Infarction
Middle Cerebral Artery
Paresis
Posterior Cerebral Artery

Figure

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  FIGURE 1 The initial CT scan shows epidural hematoma at left hemisphere.

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  FIGURE 2 Postoperative CT scan shows successful evacuation and focal low density around the left parieto-occipital sulcus.

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  FIGURE 3 MRDWI reveals multiple nodular and patchy high signal increase lesions in medial part of left temporal lobe. This is PCA and MCA terminal branch territory. Subcortical lesion of left occipital lobe (A), cortical lesions and left basal ganglia infarction were also noted (B, C, D). MRDWI: MR diffusion weight images, PCA: posterior cerebral artery, MCA: middle cerebral artery.

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