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Occipital extradural hematoma — Clinical Guidelines

Overview

Occipital extradural hematoma (EDH) is a collection of blood between the dura mater and the skull, typically resulting from trauma but occasionally occurring spontaneously, often associated with underlying pathologies such as coagulopathies, infective processes, or malignancies 1 2.

Diagnosis

Clinical Presentation: Headache, focal neurological deficits, altered consciousness 1 2.

Imaging: CT scan is definitive, showing biconvex shape typically over the temporal region 1 2 6.

Laboratory Tests: Coagulation profile, liver function tests, and other relevant blood work to identify underlying causes 1 2.

Management

Surgical Evacuation: Indicated for large hematomas (>30 mL), deteriorating neurological status, or significant mass effect 6 13 14.

Nonoperative Management: Suitable for smaller, stable hematomas in conscious patients with static or improving neurological signs 9 10.

Monitoring: Serial CT scans to assess hematoma resolution in nonoperatively managed cases 9 10.

Special Populations

Pediatrics: High frequency of lucid intervals and potential for spontaneous resolution; careful monitoring is crucial 15.

Comorbidities: Patients with coagulopathies or liver disease may require specific management of underlying conditions 1 2.

Elderly: Higher risk of complications and mortality; early intervention is critical 13 14.

Key Recommendations

Prompt Diagnosis and Treatment: Early surgical intervention for significant mass effect or neurological deterioration reduces mortality (Evidence: Strong 6 13 14).

Consider Nonoperative Management: For smaller, stable EDHs in conscious patients, nonoperative management with close monitoring can be effective (Evidence: Moderate 9 10).

Evaluate Underlying Causes: Comprehensive laboratory testing to identify and manage underlying conditions like coagulopathies or malignancies (Evidence: Moderate 1 2).

References

1 Khan KA, Chhabra S, Sharma S, Purohit D. Spontaneous extradural hematoma: a rare entity. British journal of neurosurgery 2020. link 2 Hassan MF, Dhamija B, Palmer JD, Hilton D, Adams W. Spontaneous cranial extradural hematoma: case report and review of literature. Neuropathology : official journal of the Japanese Society of Neuropathology 2009. link 3 Murphy MA, Silvester KC, Chan TY. Extradural haematoma after temporomandibular joint arthroscopy. A case report. International journal of oral and maxillofacial surgery 1993. link80660-5) 4 Tekkok IH, Cataltepe O, Tahta K, Bertan V. Extradural haematoma after continuous extradural anaesthesia. British journal of anaesthesia 1991. link 5 Puech B, Puech PF, Dhellemmes P, Pellerin P, Lepoutre F, Tichy G. Did Mozart have a chronic extradural haematoma?. Injury 1989. link90004-1) 6 Simpson DA, Heyworth JS, McLean AJ, Gilligan JE, North JB. Extradural haemorrhage: strategies for management in remote places. Injury 1988. link90100-3) 7 Iplikcioğlu AC, Ozer F, Benli K, Kutluk T, Gürçay O. Liquid extradural hematoma with congenital fibrinogen deficiency. Case report. Surgical neurology 1988. link90276-5) 8 Pozzati E, Staffa G, Nuzzo G, Frank F. Late recurrence of bleeding in a chronic extradural hematoma. The Journal of trauma 1987. link 9 Bullock R, Smith RM, van Dellen JR. Nonoperative management of extradural hematoma. Neurosurgery 1985. link 10 Pozzati E, Tognetti F. Spontaneous healing of extradural hematomas: report of four cases. Neurosurgery 1984. link 11 Keet PC. Extradural haematoma. An analysis of two 8-year series at Groote Schuur Hospital. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 1984. link 12 Pozzati E, Frank F, Frank G, Gaist G. Subacute and chronic extradural hematomas: a study of 30 cases. The Journal of trauma 1980. link 13 Phonprasert C, Suwanwela C, Hongsaprabhas C, Prichayudh P, O'Charoen S. Extradural hematoma: analysis of 138 cases. The Journal of trauma 1980. link 14 Mendelow AD, Karmi MZ, Paul KS, Fuller GA, Gillingham FJ. Extradural haematoma: effect of delayed treatment. British medical journal 1979. link 15 Choux M, Grisoli F, Peragut JC. Extradural hematomas in children. 104 cases. Child's brain 1975. link 16 Crawford JS. Pathology in the extradural space. British journal of anaesthesia 1975. link

Occipital extradural hematoma