Nigerian Journal of Basic and Clinical Sciences

CASE REPORT
Year
: 2021  |  Volume : 18  |  Issue : 2  |  Page : 156--158

Unusual presentation of epidural haematoma with ossified border on computed tomography scan


John Sheyin1, ND Chom2, SA Olarinoye Akorede3, JG Makama4,  
1 Department of Radiology, Faculty of Clinical Sciences, College of Medicine, Kaduna State University, Kaduna, Nigeria
2 Department of Radiology, College of Medicine, Ahmadu Bello University, Zaria, Nigeria
3 Department of Radiology, College of Medicine, Ahmadu Bello University, Zaria, Nigeria, Nigeria
4 Department of Surgery, Faculty of Clinical Sciences, College of Medicine, Kaduna State University, Kaduna, Nigeria

Correspondence Address:
Dr. John Sheyin
Department of Radiology, Faculty of Clinical Sciences, College of Medicine, Kaduna State University, Kaduna
Nigeria

Abstract

Ossified epidural haematoma is a rare finding in clinical practice. Neuroimaging such as computed tomographic (CT) scan plays an important role in its diagnosis and management. A 58-year-old man came for brain CT on account of 4-month history of epilepsy. He had a history of road traffic accident 4 years ago. A radiologic diagnosis of ossified epidural haematoma was made as the working diagnosis.



How to cite this article:
Sheyin J, Chom N D, Olarinoye Akorede S A, Makama J G. Unusual presentation of epidural haematoma with ossified border on computed tomography scan.Niger J Basic Clin Sci 2021;18:156-158


How to cite this URL:
Sheyin J, Chom N D, Olarinoye Akorede S A, Makama J G. Unusual presentation of epidural haematoma with ossified border on computed tomography scan. Niger J Basic Clin Sci [serial online] 2021 [cited 2023 Feb 4 ];18:156-158
Available from: https://www.njbcs.net/text.asp?2021/18/2/156/332172


Full Text



 Introduction



Chronic epidural haematoma is a collection of blood in the potential space between the inner table of the skull laterally and the dura mater medially. It is one of the causes of neurosurgical emergency globally. The incidence varies from 1.5% to 4% of all head injuries.[1],[2] It is seen in <1% of all children with cranial trauma and is quite uncommon in infants.[1]. It is more common in younger patients of between 20 and 40 years[1],[3] and usually not related to gender.

Its causes include complications of head trauma or surgical cranial procedures, e.g., craniotomy leading to bleeding from the middle-meningeal artery or one of its branches and more rarely from venous bleeding.

It is seen as a biconvex-shaped hyperdensity immediately subjacent to the vault and frequently located in the frontoparietal regions, but it may also occur in the posterior fossa, which is rare and likely to be missed.[4] Its usual shape is lost after reoccurrence or post-surgery.[4] In about 75%–95% cases, a fracture line in the skull can be demonstrated radiographically.[1],[5]

Ossification of chronic epidural haematoma is rare,[6],[7],[8],[9] since most of it is removed surgically before it occurs.[1],[2] The precise mechanism of an osseous transformation is still not well understood.[3],[10]

The time of presentation is usually in the first few days of occurrence. History of transient loss of consciousness, lucid interval, delayed somnolence, progressive deterioration of consciousness and focal neurologic signs are all symptoms and signs of epidural haematoma.

 Case Report



A 58-year-old man who was referred from a government hospital in Kaduna for a brain computed tomography (CT) scan in the Department of Radiology, Ahmadu Bello University Teaching (ABUTH) Zaria, with a history of several episodes of epilepsy of 4 months duration. There was a history of road traffic accident 4 years ago in which there was no loss of consciousness or fracture. He had only bruises on the body, which were treated. He has been well until 4 months ago when he developed generalised tonic-clonic convulsions. The generalised tonic-clonic convulsions were initially twice in a month for 1 month and subsequently, it became weekly. Each convulsion usually lasts for 15 min. There was no associated preceding aura, tongue biting, sphincteric disturbances or paresis. However, there was associated postictal sleep which usually lasts for about 10 min.

On examination, he was well preserved, not dehydrated, not pale and not in obvious respiratory distress. Examination of the central nervous system and other systems were essentially normal. Based on these findings, a diagnosis of epilepsy was suspected. Investigations requested include full blood count and differentials, urea, electrolytes and creatinine (done in state hospital and were essentially normal) and brain CT which was done at ABUTH. The cranial CT shows an extensive non-enhancing biconvex hypodense lesion with calcified border in the left fronto-parieto-occipital area. A radiological diagnosis of a chronic epidural haematoma with ossified border was made [Figure 1] and [Figure 2]. The patient had craniotomy where intraoperatively an extensive haematoma in the epidural space in the left fronto-parieto-occipital region was found and was drained. He was also placed on prophylactic antibiotics. He improved remarkably without seizure recurrence throughout his hospital stay and was discharged home.{Figure 1}{Figure 2}

 Discussion



Majority of patients with epidural haematoma present within 24 h of head injury and usually show the progressive deterioration of consciousness, a proportion presents much later as seen in this patient. Morbidity and mortality are related to a delay in diagnosis and treatment.[11]

Traumatic intracranial haematoma increases the incidence of epilepsy in both acute and late states[10] as was seen in this case.

Prior to the era of CT, the diagnosis was made by the following investigation which includes:

Exploratory burr or trephine holes[3],[5]Skull radiography showing shift of calcified pineal gland[3]Carotid angiography[3],[5]Ventriculography[3]Pneumoencephalography[5] and nuclear scanning.[12]

CT has overtaking the above mention investigations, it is reliable in demonstrating intracranial haematomas and other associated intracranial lesions, which are important for prognosis.

Magnetic resonance imaging can also be used, but the calcific components may be missedUltrasound is also used before the closure of the fontanelles in children which was not applicable in this caseThe main treatment is craniotomy; other mode of treatment is conservative management.[2],[11]

Our index patient was an elderly man, who presented with generalised tonic-clonic seizures, preceding history of head trauma, radioimaging evidence of chronic epidural haematoma with ossified border in the fronto-parieto-occipital areas; he had craniotomy with remarkable improvement.

 Summary



A case of an unusual presentation of epidural haematoma has been presented. The clinical features, radiological diagnosis and the review of literature have been discussed.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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