Volume : VIII, Issue : VIII, August - 2019

POSTERIOR–FOSSA EXTRADURAL HAEMATOMA–DIAGNOSTIC DILEMMA AND MANAGEMENT DIFFICULTIES

Dr. Sanghmitra Sarkar, Dr. Payoz Pandey

Abstract :

Extradural hemorrhage (EDH) results from collection of blood between the dura and the calvaria as a consequences of head injury. Extradural haematoma occurs in approximately 2–% of all patient with head injury.Though posterior fossa extradural hematoma(PFEDH) is much less frequent than it‘s supratentorial counterpart it is the most common traumatic space occupying lesion in this location. It accounts for approximately 0.3% of all craniocereal injuries and constitutes 2.7–11% of all intracranial epidural hematomas (EDH).It is a potentially lethal sequelae of head injury, as it may be silent or slow to develop, but deterioration may be sudden and rapid, becoming fatal, if not promptly treated. Mortality is high in PFEDH is due to the small volume of the posterior fossa and contained important structures. A high index of suspicion is needed for proper intervention for prevention of morbidity and mortality. AIMS AND OBJECTIVES:The aim of the present study was to share the experience of 27 cases and review the literature concerning PFEDH for earlier diagnosis and better management of PFEDH MATERIALS AND METHODS:Our study is a prospective analysisof patients who had presented to us with Posterior fossa Epidural Hematoma from Sep 2017– March 2019(30 months).in the Department of Neurosurgery, Calcutta National Medical College and Hospital (CNMC &H). RESULT ANALSIS: This prospective study of 27 patients with PFEDH during a period of30 months has revealed the following facts: EDH accounts for 2.27% of Neurosurgical admissions. PFEDH constitutes 19.6% of EDH. Male: Female ratio is 1.69:1(M17;F10).55.5%,(15) of patients were below 15 yrs of age. Frequently the cause was fall from a height n= 15 (55.5% ) followed by road traffic accident n=5 (18.5% )and trauma over back of skull n=4 (14.8%). Patients present mostly with features of raised I.C.P such as headache vomiting papilloedema n=17 (62.96%). 22.2% of patients(n=6) were asymptomatic at presentation. X–ray skull detected fracture of occipital bone in 74.08% of cases(20cases) which had frequent association with PFEDH . At follow up, the outcome was evaluated using the Glasgow outcome scale (GOS). The patients were classified into five groups according to the GOS : Good recovery n= 16( 59.25%) . Moderate disability n= 5 (18.51%). Severe disability n= 3 (11.11%). Persistent vegetative state n=1 (3.70%). Death n=1 (3.70%). CONCLUSION: PFEDH is a potentially lethal complication of head injury.Children and Young and active males are the usual victims. High degree of suspicion and awareness of its occurrence isneeded in any case of head injury which might be asymptomatic withG.C.S score of 15, and /or with evidence of local trauma overposterior aspect of skull.C.T scan of ain should be requisitioned in any case of headinjury, so that a prompt diagnosis can be made and managementinstituted. With proper evaluation and management a fair number of patientsrespond to conservative treatment. Overall prognosis of PFEDH is good, if there is no concomitant ainstem injury.

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Article: Download PDF   DOI : 10.36106/ijsr  

Cite This Article:

POSTERIOR-FOSSA EXTRADURAL HAEMATOMA-DIAGNOSTIC DILEMMA AND MANAGEMENT DIFFICULTIES, Dr.Sanghmitra Sarkar, Dr.Payoz Pandey INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH : Volume-8 | Issue-8 | August-2019

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