Epidural hematoma diagnostic study of choice: Difference between revisions

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The following finding(s) on performing CT scan are confirmatory for epidural hematoma:
The following finding(s) 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.
* 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 may be visualized in some cases of epidural hematoma in CT scan.
* 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>
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===== Sequence of Diagnostic Studies =====
===== Sequence of Diagnostic Studies =====
The [name of investigation] should be performed when:
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>
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
*Age > 60 years
* A positive [test] is detected in the patient, to confirm the diagnosis.
*[[Glasgow coma scale|Glasgow Coma Scale]] under 15
*[[Headache]]
*[[Vomiting]]
*[[Loss of consciousness]]
*[[Amnesia]]
*[[Alcohol intoxication|Alcohol]] or [[drug intoxication]]


=== Diagnostic Criteria ===
* Here you should describe the details of the diagnostic criteria.
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for the diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
** Criteria 1
** Criteria 2
** Criteria 3
IF there are clear, established diagnostic criteria:
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria:
*There are no established criteria for the diagnosis of [disease name].
===Indication of CT scan in 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:<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
**[[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]].
*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 />
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Revision as of 17:09, 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. 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 finding(s) 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 may be visualized in some cases of epidural hematoma in CT scan.
  • Depending on the size of hematoma, secondary features of mass effect may be present which include:
    • Midline shift[1]
    • Subfalcine herniation[2]
    • Uncal herniation[3]
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:[4][5][6][7]

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
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