Epidural hematoma diagnostic study of choice: Difference between revisions
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== Overview == | == Overview == | ||
The CT scan is the gold standard test for the diagnosis of epidural hematoma. Among patients with head trauma CT scan is indicated for detecting epidural hematoma and other kind of [[Intracranial hemorrhage|intracranial hemorrhages]] in patients with: age > 60 years, [[Glasgow coma scale|glasgow Coma Scale]] under 15, [[Headache]], [[Vomiting]], [[Loss of consciousness]], [[Amnesia]], [[Alcohol intoxication|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]]. | 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 [[Dura mater|dural]] reflections unlike a [[subdural hematoma]] but it '''does not cross''' [[skull]]'s suture lines where the [[Dura mater|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 hemorrhage|intracranial hemorrhages]] in patients with: age > 60 years, [[Glasgow coma scale|glasgow Coma Scale]] under 15, [[Headache]], [[Vomiting]], [[Loss of consciousness]], [[Amnesia]], [[Alcohol intoxication|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]]. | ||
== Diagnostic Study of Choice == | == Diagnostic Study of Choice == | ||
=== Study of choice === | === Study of choice === | ||
The CT scan is the gold standard test for the diagnosis of epidural hematoma. | The [[Computed tomography|CT scan]] is the [[Gold standard (test)|gold standard]] test for the diagnosis of epidural hematoma. | ||
===== Diagnostic results ===== | ===== Diagnostic results ===== | ||
The following | 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.<ref name="pmid21274684">{{cite journal| author=Kim JJ, Gean AD| title=Imaging for the diagnosis and management of traumatic brain injury. | journal=Neurotherapeutics | year= 2011 | volume= 8 | issue= 1 | pages= 39-53 | pmid=21274684 | doi=10.1007/s13311-010-0003-3 | pmc=3026928 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21274684 }} </ref><ref name="pmid18701165">{{cite journal| author=Huisman TA, Tschirch FT| title=Epidural hematoma in children: do cranial sutures act as a barrier? | journal=J Neuroradiol | year= 2009 | volume= 36 | issue= 2 | pages= 93-7 | pmid=18701165 | doi=10.1016/j.neurad.2008.06.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18701165 }} </ref> | * Bi-convex (or [[lentiform]]) shaped [[hematoma]] in [[epidural space]] which '''can cross''' the [[Dura mater|dural]] reflections unlike a [[subdural hematoma]] but it '''does not cross''' [[skull]]'s suture lines where the [[Dura mater|dura]] tightly adheres to the adjacent [[skull]].<ref name="pmid21274684">{{cite journal| author=Kim JJ, Gean AD| title=Imaging for the diagnosis and management of traumatic brain injury. | journal=Neurotherapeutics | year= 2011 | volume= 8 | issue= 1 | pages= 39-53 | pmid=21274684 | doi=10.1007/s13311-010-0003-3 | pmc=3026928 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21274684 }} </ref><ref name="pmid18701165">{{cite journal| author=Huisman TA, Tschirch FT| title=Epidural hematoma in children: do cranial sutures act as a barrier? | journal=J Neuroradiol | year= 2009 | volume= 36 | issue= 2 | pages= 93-7 | pmid=18701165 | doi=10.1016/j.neurad.2008.06.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18701165 }} </ref> | ||
* Depressed skull fracture may be visualized in some cases of epidural hematoma in CT scan.<ref name="pmid18389258">{{cite journal| author=Vitali AM, Steinbok P| title=Depressed skull fracture and epidural hematoma from head fixation with pins for craniotomy in children. | journal=Childs Nerv Syst | year= 2008 | volume= 24 | issue= 8 | pages= 917-23; discussion 925 | pmid=18389258 | doi=10.1007/s00381-008-0621-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18389258 }} </ref> | * Depressed [[skull fracture]] may be visualized in some cases of epidural hematoma in CT scan.<ref name="pmid18389258">{{cite journal| author=Vitali AM, Steinbok P| title=Depressed skull fracture and epidural hematoma from head fixation with pins for craniotomy in children. | journal=Childs Nerv Syst | year= 2008 | volume= 24 | issue= 8 | pages= 917-23; discussion 925 | pmid=18389258 | doi=10.1007/s00381-008-0621-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18389258 }} </ref> | ||
* Depending on the size of hematoma, secondary features of mass effect may be present which include: | * Depending on the size of [[hematoma]], secondary features of mass effect may be present which include: | ||
** Midline shift<ref name="pmid23320175">{{cite journal| author=Chen H, Guo Y, Chen SW, Wang G, Cao HL, Chen J et al.| title=Progressive epidural hematoma in patients with head trauma: incidence, outcome, and risk factors. | journal=Emerg Med Int | year= 2012 | volume= 2012 | issue= | pages= 134905 | pmid=23320175 | doi=10.1155/2012/134905 | pmc=3536037 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23320175 }} </ref> | ** Midline shift<ref name="pmid23320175">{{cite journal| author=Chen H, Guo Y, Chen SW, Wang G, Cao HL, Chen J et al.| title=Progressive epidural hematoma in patients with head trauma: incidence, outcome, and risk factors. | journal=Emerg Med Int | year= 2012 | volume= 2012 | issue= | pages= 134905 | pmid=23320175 | doi=10.1155/2012/134905 | pmc=3536037 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23320175 }} </ref> | ||
** Subfalcine herniation<ref name="pmid28966825">{{cite journal| author=Ben-Israel D, Isaacs AM, Morrish W, Gallagher NC| title=Acute vertex epidural hematoma. | journal=Surg Neurol Int | year= 2017 | volume= 8 | issue= | pages= 219 | pmid=28966825 | doi=10.4103/sni.sni_218_17 | pmc=5609442 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28966825 }} </ref> | ** Subfalcine [[herniation]]<ref name="pmid28966825">{{cite journal| author=Ben-Israel D, Isaacs AM, Morrish W, Gallagher NC| title=Acute vertex epidural hematoma. | journal=Surg Neurol Int | year= 2017 | volume= 8 | issue= | pages= 219 | pmid=28966825 | doi=10.4103/sni.sni_218_17 | pmc=5609442 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28966825 }} </ref> | ||
** Uncal herniation<ref name="pmid21274684">{{cite journal| author=Kim JJ, Gean AD| title=Imaging for the diagnosis and management of traumatic brain injury. | journal=Neurotherapeutics | year= 2011 | volume= 8 | issue= 1 | pages= 39-53 | pmid=21274684 | doi=10.1007/s13311-010-0003-3 | pmc=3026928 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21274684 }} </ref> | ** [[Uncal herniation]]<ref name="pmid21274684">{{cite journal| author=Kim JJ, Gean AD| title=Imaging for the diagnosis and management of traumatic brain injury. | journal=Neurotherapeutics | year= 2011 | volume= 8 | issue= 1 | pages= 39-53 | pmid=21274684 | doi=10.1007/s13311-010-0003-3 | pmc=3026928 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21274684 }} </ref> | ||
===== Sequence of Diagnostic Studies ===== | ===== Sequence of Diagnostic Studies ===== | ||
Among patients with head trauma CT scan is indicated for detecting epidural hematoma and other kind of [[Intracranial hemorrhage|intracranial hemorrhages]] in patients with:<ref name="pmid22090740">{{cite journal| author=Sharif-Alhoseini M, Khodadadi H, Chardoli M, Rahimi-Movaghar V| title=Indications for brain computed tomography scan after minor head injury. | journal=J Emerg Trauma Shock | year= 2011 | volume= 4 | issue= 4 | pages= 472-6 | pmid=22090740 | doi=10.4103/0974-2700.86631 | pmc=3214503 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22090740 }} </ref><ref name="pmid17652914">{{cite journal| author=Ono K, Wada K, Takahara T, Shirotani T| title=Indications for computed tomography in patients with mild head injury. | journal=Neurol Med Chir (Tokyo) | year= 2007 | volume= 47 | issue= 7 | pages= 291-7; discussion 297-8 | pmid=17652914 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17652914 }} </ref><ref name="pmid15897957">{{cite journal| author=Lee B, Newberg A| title=Neuroimaging in traumatic brain imaging. | journal=NeuroRx | year= 2005 | volume= 2 | issue= 2 | pages= 372-83 | pmid=15897957 | doi=10.1602/neurorx.2.2.372 | pmc=1064998 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15897957 }} </ref><ref name="pmid22515129">{{cite journal| author=Shima H, Yasuda M, Nomura M, Mori K, Miyashita K, Tamase A et al.| title=A spinal epidural hematoma with symptoms mimicking cerebral stroke. | journal=Nagoya J Med Sci | year= 2012 | volume= 74 | issue= 1-2 | pages= 207-10 | pmid=22515129 | doi= | pmc=4831268 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22515129 }} </ref> | Among patients with head trauma [[Computed tomography|CT scan]] is indicated for detecting epidural hematoma and other kind of [[Intracranial hemorrhage|intracranial hemorrhages]] in patients with:<ref name="pmid22090740">{{cite journal| author=Sharif-Alhoseini M, Khodadadi H, Chardoli M, Rahimi-Movaghar V| title=Indications for brain computed tomography scan after minor head injury. | journal=J Emerg Trauma Shock | year= 2011 | volume= 4 | issue= 4 | pages= 472-6 | pmid=22090740 | doi=10.4103/0974-2700.86631 | pmc=3214503 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22090740 }} </ref><ref name="pmid17652914">{{cite journal| author=Ono K, Wada K, Takahara T, Shirotani T| title=Indications for computed tomography in patients with mild head injury. | journal=Neurol Med Chir (Tokyo) | year= 2007 | volume= 47 | issue= 7 | pages= 291-7; discussion 297-8 | pmid=17652914 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17652914 }} </ref><ref name="pmid15897957">{{cite journal| author=Lee B, Newberg A| title=Neuroimaging in traumatic brain imaging. | journal=NeuroRx | year= 2005 | volume= 2 | issue= 2 | pages= 372-83 | pmid=15897957 | doi=10.1602/neurorx.2.2.372 | pmc=1064998 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15897957 }} </ref><ref name="pmid22515129">{{cite journal| author=Shima H, Yasuda M, Nomura M, Mori K, Miyashita K, Tamase A et al.| title=A spinal epidural hematoma with symptoms mimicking cerebral stroke. | journal=Nagoya J Med Sci | year= 2012 | volume= 74 | issue= 1-2 | pages= 207-10 | pmid=22515129 | doi= | pmc=4831268 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22515129 }} </ref> | ||
*Age > 60 years | *Age > 60 years | ||
*[[Glasgow coma scale|Glasgow Coma Scale]] under 15 | *[[Glasgow coma scale|Glasgow Coma Scale]] under 15 | ||
| Line 33: | Line 33: | ||
*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]]. | *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]]. | ||
<references /> | <references /> | ||
Revision as of 17:22, 5 June 2018
Template:Diagnostic study of choice
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.
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.
- ↑ 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.