Ischemic stroke of middle cerebral artery territory after the traumatic epidural hematoma

• Published in: Revista de neurologiá Vol. 28; no. 10; pp. 978 - 981
• Main Authors: Moros-Peña, M, Ruiz, J A, Molina, I, Abenia, P, Melendo, J, López-Pisón, J
• Format: Journal Article
• Language: Spanish
• Published: Spain 16-05-1999
• Subjects: Brain - blood supply; Brain - diagnostic imaging; Brain Ischemia - diagnosis; Brain Ischemia - etiology; Child, Preschool; Craniocerebral Trauma - complications; Craniocerebral Trauma - diagnosis; Hematoma, Epidural, Cranial - complications; Hematoma, Epidural, Cranial - diagnosis; Hematoma, Epidural, Cranial - surgery; Humans; Injury Severity Score; Male; Subarachnoid Hemorrhage - complications; Subarachnoid Hemorrhage - diagnosis; Subarachnoid Hemorrhage - surgery; Tomography, X-Ray Computed
• ISSN: 0210-0010

Epidural haematoma is a complication which may occur after apparently minor head injury. It may lead to the sudden onset, after a variable lucid interval, of transtentorial uncal hernia with consequent risk to life. If drainage is done early, the prognosis is excellent.
We present a case of right parietal epidural haematoma in a 5 year-old-boy following a minor head injury, with no fracture of the skull. After a clear interval of 40 hours his consciousness deteriorated, there was right mydriasis and extension hypertonia of arms and legs. Following surgical removal there was evidence of an extensive cerebrovascular accident in the territory of the middle cerebral artery.
Although they are infrequent, infarcts have been described in relation to epidural haematoma in all cerebral territories, predominantly in the distribution of the posterior cerebral artery. In the territory of the middle cerebral artery this may be due to traction and stenosis or occlusion of the small perforating branches, secondary to the displacement of midline cerebral structures or the space-occupying effect of epidural haematoma. All head injuries, including minor injuries mean a risk of serious hemorrhagic complications, the prognosis of which depends on the rapidity with which they are treated.
Adapted to each centre are necessary for a common problem, usually without complications, but which may have unpredictably fatal results. Head injury is a dynamic process and therefore requires close clinical observation, which cannot be substituted by any complementary test.