Korean J Neurotrauma.  2018 Oct;14(2):138-141. 10.13004/kjnt.2018.14.2.138.

Rapid Redistribution of an Acute Traumatic Epidural Hematoma in a Patient with Invasive Skull Cancer

• Lee H
• Hwang SC
• Lee AL
• Kim CG
• Im SB

• KMID: 2424327
• DOI: http://doi.org/10.13004/kjnt.2018.14.2.138

Abstract

The rapid spontaneous resolution of an acute epidural hematoma (EDH) has rarely been reported. A possible mechanism of spontaneous resolution is egress of the hematoma into the subgaleal space through a skull fracture. We report a case of rapid redistribution of an acute EDH in a 37-year-old man who had a malignant peripheral nerve sheath tumor of the skull and who slipped and fell when going to the bathroom. A huge EDH without a skull fracture developed in the left parieto-occipital area. The acute EDH was completely alleviated and a newly developed intracerebral hematoma was found on a brain computed tomography scan that was acquired the day after the trauma. Given these findings, a fractured skull and increased pressure in the intradural area may have been the mechanisms underlying the redistribution of the hematoma.

Keyword

Epidural hematoma; Malignant nerve sheath tumor; Neurofibromatosis; Resolution; Skull fracture

MeSH Terms

Adult
Brain
Hematoma*
Humans
Neurofibromatoses
Peripheral Nerves
Skull Fractures
Skull*

Figure

• 

  FIGURE 1 Radiological images related to the tumor. (A) A round heterogeneous mass on the midline of the occipital skull was detected in a T2-weighted axial image. It was a benign neurofibroma. (B) A new mass developed in the left occipito-temporal scalp at 16 months after the midline tumor was excised. This was confirmed to be a malignant peripheral nerve sheath tumor. The skull and scalp lesions were irradiated. (C) A pleural mass was found in the right chest at 3 years after the scalp malignancy was diagnosed. Palliative chemotherapy was administered.

• 

  FIGURE 2 Radiological images of the epidural hematoma. (A, B) A huge epidural hematoma was found in the right temporo-parietal area on a brain computed tomography (CT) scan taken immediately after the trauma. (C) Small bone chips were evident in the hematoma. Osteolysis of the inner skull and a bony defect on the occipital skull were detected. (D) No skull fractures were observed. (E) A brain CT scan the day after the trauma revealed that the hematoma had disappeared and an intracerebral hematoma had newly developed on the putamen. (F) Subgaleal swelling, as revealed by a follow-up CT scan, was minimal.

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