Follow-up of Conservatively Managed Epidural Hematomas: Implications for Timing of Repeat CT
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Thomas P. Sullivana,
Jeffrey G. Jarvik,a and
Wendy A. Cohena
a From the Department of Radiology, University of Washington Medical Center, 1959 NE Pacific St, 357115, Seattle, WA 98195.
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FIG 1. Graph of RTS subgroups in patients (enlarging EDH under conservative management) and control subjects (stable EDH). Note that a higher RTS indicates less severe injury, and an RTS of 4 indicates an intubated and paralyzed patient
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FIG 2. Unenhanced CT scans of a 36-year-old male assault victim (initial CT scan 2 hours after injury).
A and B (at a level 5 mm contiguously higher than A), Scans show a left temporal EDH, 2 cm in width. The patient was neurologically normal at the time of the initial CT scan.
C and D (at a level 5 mm contiguously higher than C), Follow-up scans 10 hours later, after decline in neurologic status prompted repeat scanning. The EDH enlarged to 3 cm in width, associated with early ipsilateral uncal herniation. The patient underwent surgical evacuation and was discharged to a skilled nursing facility after a 17-day hospitalization.
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FIG 3. Unenhanced CT scans of an 87-year-old woman struck by a car (initial CT scan 2 hours after injury).
A and B (at a level 15 mm higher than A), Scans show a 12-mm-wide high-right-convexity EDH with subarachnoid hemorrhage in the right parietal lobe inferiorly. The patient had a neurologic deficit, but surgery was not performed because of the patient's religious preferences. A further decline in neurologic status prompted a follow-up scan 9 hours later.
C and D (at a level 10 mm higher than C), Scans show an increase in width of the high-right-convexity EDH to 18 mm, with ipsilateral parenchymal hemorrhage and severe right to left midline shift. The patient did not survive the injury.
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AJNR - American Journal of Neuroradiology