Orbitofrontal Extradural Hematoma: Unusual Cause of Proptosis

Traumatic orbital subperiosteal hematoma are a distinct entity and should not be confused with orbital extradural hematoma. Most of the orbital subperiosteal hematoma are small in volume and resolve spontaneously. Management should be based on the clinico-radiological condition. A delayed proptosis may be simply due to orbital venous congestion due to a substantial hematoma or due to a carotid-cavernous fistula. Differentiation between the two is paramount to decide management strategy.

Determine the Outcome of Traumatic Extradural Hematoma and to Compare the Outcome of Small and Large Size Extradural Hematoma

Objective: The aim of this study is to determine the outcome of traumatic extradural hematoma and to compare the outcome of small and large size extradural hematoma. Study Design: Descriptive case study Place and Duration: Study was conducted at the department of Neurosurgery, Saidu Teaching Hospital, Saidu Sharif, Swat for duration of two years from January 2016 to December 2017. Methods: Total one hundred and forty patients of both genders with ages 2-70 years were presented. Patients had traumatic extradural hematoma within duration first 24 hours were included and admitted through the emergency department. Detailed demographics of enrolled cases age, sex, GCS on arrival and cause of injury were recorded after taking informed written consent. CT scan of all the patients was done for diagnosis. Glasgow Outcome Score (GOS) was used for determination of outcomes. SPSS 23.0 version was used to analyze the data. Results: There were 110 (78.6%) male patients and 30 (21.4%) patients were females. Mean age of the patients was 32.78±10.43 years. RTA was the most common cause found in 84 (60%) followed by falling 29 (20.7%) and assault in 27 (19.3%). Small size hematoma volume among 100 (71.4%) cases and large size was in 40 (28.6%) patients. According to Glasgow outcome score, 24 (17.1%) cases had 1-3 score and 116 (82.9%) cases had 4-5 score. Mean GOS was 4.01±1.12. We found successful outcomes among 116 (82.9%) cases in which majority of the patients were from small size extradural hematoma. Conclusion: We concluded in this study that a significant relationship exists between the volume of extradural hematoma and both the clinical and functional outcome. Prognosis becomes increasingly worse with rising extradural hematoma size. Keywords: Traumatic Brain Injury, Extradural Hematoma, Glasgow Outcome Score

Incidence, ethology and location of extradural hematoma in surgically managed patients

One of the major public health issues worldwide is traumatic brain injury. EDH is most commonly located in the temporoparietal region. Proper and timely management of these patients improves the outcome. To interpret theincidence, etiology and location of EDH in surgically managed patients.Surgically operated EDH patients were epidemiologically analysed as per the age, gender, mechanism of injury, GCS at admission, site of hematoma and associated intracranial injuries.: Epidemiological analysis of thirty operated EDH patients was done.: Statistical evaluation was done .EDH was more common (76.67%) among males than females (23.33%). Mostly patients (50%) were in the age group of 21-41 years. Road traffic accident was the most common (50%) mode of trauma leading to EDH occurrence. Temporoparietal EDH was the most common (36.66%) location on CT scan. Most common (70%) associated intracranial injury observed was the skull fractures.: EDH is a serious complication of head injury. Early diagnosis and proper management is required. EDH is more common in men. Careful interpretation of CT scan head is important to get information about the location EDH and other associated injuries before proceeding for surgical evacuation.

Contusion Index is an Important Tool for the Management of Traumatic Intracerebral Hematoma

Objective This article evaluates outcome of traumatic intracerebral hematomas in terms of Glasgow Coma Scale (GCS) after medical or surgical management according to contusion index. Materials and Methods This descriptive study was conducted in the Department of Neurosurgery, Lady Reading Hospital, Peshawar, Pakistan from January 2017 to December 2018. Total number of patients with traumatic intracerebral contusions included in this study was 60 with age between 5 and 75 years. Both male and female were included. Patients with other coexisting traumatic intracranial hematomas like extradural hematoma, subdural hematoma, and polytrauma were excluded from this study. Contusion index of patients were calculated by noncontrast-enhanced computed tomography brain. On arrival patient GCS was documented. The management protocol, that is, conservative or surgical, was provided to individual patient according to contusion index as calculated. Outcome of management was assessed in terms of GCS. Results Patients with contusion index of 0 to 4 were managed conservatively. Patients with contusion index of 6 were offered surgical management. Patients with contusion index of 9 had poor outcome with both conservative and surgical management. Conclusion Contusion index can be used reliably as a tool for management of isolated traumatic intracerebral hematomas

Post-Traumatic Subfrontal with Orbital Extradural Hematoma and Proptosis (Unusual Presentation Managed with Needle Aspiration) A Case Report with Review of Literature

Extradural hematoma (EDH) is a common intracranial pathology following motor vehicle accidents, comprising approximately 0.2 to 6% of all head injuries. The association of EDH with subperiosteal intraorbital hematomas is rarely reported. We report a case of a traumatic subfrontal EDH with subperiosteal hematoma (orbital EDH) successfully treated with needle aspiration, demonstrating that in appropriate patients, needle aspiration can result in the resolution of symptoms without an invasive procedure.

Orbitofrontal Extradural Hematoma: Unusual Cause of Proptosis

<b><i>Introduction:</i></b> Frontal extradural hematoma (EDH) extending into orbit is an uncommon entity. Clinical presentation can be subacutely progressive proptosis following head injury. <b><i>Case Presentation:</i></b> We present a case of frontal EDH with orbital extension which had delayed progressive proptosis. The patient improved clinically after surgical evacuation of EDH. <b><i>Conclusion:</i></b> It is important to look for orbital roof fractures, orbital hematoma in cases of head injury. Such cases should be treated surgically at the earliest.

Duret Hemorrhage after Extradural Hematoma Evacuation–A Rare Entity

Traumatic brainstem injury can be classified as primary or secondary. Secondary brainstem hemorrhage that evolves from raised intracranial pressure (ICP) and transtentorial herniation is referred to as Duret hemorrhage. We report a 25-year-old male who underwent emergency craniotomy, with evacuation of acute epidural hematoma, and postoperatively developed fatal Duret hemorrhage. Duret hemorrhage after acute epidural hematoma (EDH) evacuation is a very rare complication and the outcome is grave in most of the cases.

Posterior reversible encephalopathy syndrome and spinal extradural hematoma in an elderly patient

Posterior reversible encephalopathy syndrome (PRES) is identified on magnetic resonance imaging by posterior predominant white and gray matter lesions. PRES secondary to spinal disease is very rare. We report a case of clinical and imaging findings about PRES associated with spinal epidural hematoma.