Extradural venous hematoma

Case contributed by A.Prof Frank Gaillard

Presentation

Fall onto hard surface. Headache.

Patient Data

Age: 30 years
CT

Overlying the parietal bone towards the vertex immediately underneath the parietal bone, there is an area of extra-axial hyperdensity, which is best appreciated on the sagittal reconstructions. There is adjacent subgaleal hematoma overlying this extending posteriorly towards the parieto-occipital bone, but no underlying fracture is seen. There is compression and displacement of the adjacent superior sagittal sinus due to its mass effect. 

Conclusion:

Appearances are characteristic of a venous epidural hematoma

MRI

MRI 4 weeks later

MRI one month later demonstrates a persisting subdural hematoma. The previously demonstrated venous extradural hematoma has resolved. 

Case Discussion

The rule of "extradural hematomas shall not cross suture lines" is only valid if the sutures are intact. Even a diastasis which is difficult to appreciate can tear the parietal dura and allow for extradural venous hemorrhage. 

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Case information

rID: 50387
Published: 28th Jan 2017
Last edited: 28th Jan 2017
Inclusion in quiz mode: Included

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