Epidural hematoma diagnostic study of choice
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
The CT scan is the gold standard test for the diagnosis of epidural hematoma. The following findings on performing CT scan are confirmatory for epidural hematoma: Bi-convex (or lentiform) shaped hematoma in epidural space which can cross the dural reflections unlike a subdural hematoma but it does not cross skull's suture lines where the dura tightly adheres to the adjacent skull, depressed skull fracture in some cases of epidural hematoma, midline shift of brain tissue, subfalcine herniation and uncal herniation. Among patients with head trauma CT scan is indicated for detecting epidural hematoma and other kind of intracranial hemorrhages in patients with: age > 60 years, glasgow Coma Scale under 15, Headache, Vomiting, Loss of consciousness, Amnesia, alcohol or drug intoxication. Screening for cervical spinal hematoma by CT scan is recommended among patients with acute onset of hemiparesis, specially when they are associated with neck pain. MRI is the preferred imaging study for diagnosis of spinal epidural hematoma. In patients with spinal epidural hematoma findings on MRI suggestive of spinal epidural hematoma include: A variable signal intensity( Isointensity to cord in T1-weighted images and Hyperintensity with areas of hypointensity in T2-weighted images), capping of epidural fat, direct continuity with the adjacent osseous structures and compression of epidural fat, subarachnoid sac, and spinal cord. MRI is sensitive for diagnosis of intracranial epidural hematoma but it is rarely used for diagnosis of it because of its limited availability and because more time is needed to prepare the patients for MRI.
Diagnostic Study of Choice
Study of choice
The CT scan is the gold standard test for the diagnosis of epidural hematoma.
Diagnostic results
The following findings on performing CT scan are confirmatory for epidural hematoma:
- Bi-convex (or lentiform) shaped hematoma in epidural space which can cross the dural reflections unlike a subdural hematoma but it does not cross skull's suture lines where the dura tightly adheres to the adjacent skull.[1][2]
- Depressed skull fracture may be visualized in some cases of epidural hematoma in CT scan.[3]
- Depending on the size of hematoma, secondary features of mass effect may be present which include:
- Midline shift[4]
- Subfalcine herniation[5]
- Uncal herniation[1]
Sequence of Diagnostic Studies
Among patients with head trauma CT scan is indicated for detecting epidural hematoma and other kind of intracranial hemorrhages in patients with:[6][7][8][9]
- Age > 60 years
- Glasgow Coma Scale under 15
- Headache
- Vomiting
- Loss of consciousness
- Amnesia
- Alcohol or drug intoxication
- Screening for cervical spinal hematoma by CT scan is recommended among patients with acute onset of hemiparesis, specially when they are associated with neck pain.
Spinal epidural hematoma
- In patients with spinal epidural hematoma findings on MRI suggestive of spinal epidural hematoma include:[10][11]
- A variable signal intensity:
- Isointensity to cord in T1-weighted images
- Hyperintensity with areas of hypointensity in T2-weighted images
- Capping of epidural fat
- Direct continuity with the adjacent osseous structures
- Compression of epidural fat, subarachnoid sac, and spinal cord
- A variable signal intensity:
References
- ↑ 1.0 1.1 Kim JJ, Gean AD (2011). "Imaging for the diagnosis and management of traumatic brain injury". Neurotherapeutics. 8 (1): 39–53. doi:10.1007/s13311-010-0003-3. PMC 3026928. PMID 21274684.
- ↑ Huisman TA, Tschirch FT (2009). "Epidural hematoma in children: do cranial sutures act as a barrier?". J Neuroradiol. 36 (2): 93–7. doi:10.1016/j.neurad.2008.06.003. PMID 18701165.
- ↑ Vitali AM, Steinbok P (2008). "Depressed skull fracture and epidural hematoma from head fixation with pins for craniotomy in children". Childs Nerv Syst. 24 (8): 917–23, discussion 925. doi:10.1007/s00381-008-0621-9. PMID 18389258.
- ↑ Chen H, Guo Y, Chen SW, Wang G, Cao HL, Chen J; et al. (2012). "Progressive epidural hematoma in patients with head trauma: incidence, outcome, and risk factors". Emerg Med Int. 2012: 134905. doi:10.1155/2012/134905. PMC 3536037. PMID 23320175.
- ↑ Ben-Israel D, Isaacs AM, Morrish W, Gallagher NC (2017). "Acute vertex epidural hematoma". Surg Neurol Int. 8: 219. doi:10.4103/sni.sni_218_17. PMC 5609442. PMID 28966825.
- ↑ Sharif-Alhoseini M, Khodadadi H, Chardoli M, Rahimi-Movaghar V (2011). "Indications for brain computed tomography scan after minor head injury". J Emerg Trauma Shock. 4 (4): 472–6. doi:10.4103/0974-2700.86631. PMC 3214503. PMID 22090740.
- ↑ Ono K, Wada K, Takahara T, Shirotani T (2007). "Indications for computed tomography in patients with mild head injury". Neurol Med Chir (Tokyo). 47 (7): 291–7, discussion 297-8. PMID 17652914.
- ↑ Lee B, Newberg A (2005). "Neuroimaging in traumatic brain imaging". NeuroRx. 2 (2): 372–83. doi:10.1602/neurorx.2.2.372. PMC 1064998. PMID 15897957.
- ↑ Shima H, Yasuda M, Nomura M, Mori K, Miyashita K, Tamase A; et al. (2012). "A spinal epidural hematoma with symptoms mimicking cerebral stroke". Nagoya J Med Sci. 74 (1–2): 207–10. PMC 4831268. PMID 22515129.
- ↑ 10.0 10.1 Sklar EM, Post JM, Falcone S (1999). "MRI of acute spinal epidural hematomas". J Comput Assist Tomogr. 23 (2): 238–43. PMID 10096331.
- ↑ 11.0 11.1 Braun P, Kazmi K, Nogués-Meléndez P, Mas-Estellés F, Aparici-Robles F (2007). "MRI findings in spinal subdural and epidural hematomas". Eur J Radiol. 64 (1): 119–25. doi:10.1016/j.ejrad.2007.02.014. PMID 17353109.