Bilateral Extradural Hematomas in a Thrombocytopenic Infant Receiving Anticoagulants: Case Report

Abstract

A unique case of bilateral extradural hematomas in an infant is reported. Relevant aspects of the patient's history, including the absence of any known trauma and the presence of an underlying coagulopathy are discussed. The radiographic and operative findings of this case are presented, and an explanation of the mechanism of the hematomas is offered.

Nontraumatic Intracranial Epidural Hematoma: Systematic Review of the Literature

“…It is known that coagulopathies may be responsible for spontaneous bleeding, including epidural bleeding. 41 In the present study, the observed coagulopathies (►Table 3) were: sickle cell anemia (SCA), 2,42,43,44,45,46,47,48,49,50 coagulation factor XIII deficiency, 51,52 hypofibrinogenemia, 53,54 vitamin K deficiency, 55 congenital afibrinogenemia, 56,57 immune thrombocytopenic purpura, 27,58 myelodysplastic syndrome, 59 disseminated intravascular coagulation (DIC), 60 and liver disease 61 . Coagulation disorders and pericranial infections are the two major categories of pathologies with which EDH is associated.…”

“…Given this, hypercoagulability and venous stasis may be the connective link between ITP and spontaneous subdural and epidural hemorrhages, by venous rupture and dissection of the periosteal layer of the meningeal, respectively. 27,71 There is a case report in the literature of spontaneous EDH associated with myelodysplastic syndrome (MDS) described by Grabel et al 59 in a child on daily warfarin use. The cause of bleeding remains obscure due to the previous coagulopathy of the patient.…”

Hematoma epidural espontâneo: relato de dois casos

“…Os distúrbios da coagulação congênitos ou adquiridos 14 constituem, junto com as infecções pericranianas, as duas grandes categorias de patologias às quais os HED espontâneos costumam se associar. Kuwayama e col. 15 relataram o caso de uma paciente que desenvolveu HED espontâneo bilateral e relacionaram a etiologia do sangramento a hipofibrinogenemia adquirida.…”

“…Cerca de 83 a 95% dos casos estão associados a fraturas de crânio [2][3][4][5] ; porém, quando não há história ou sinais de traumatismo e na ausência de fraturas de crânio, pode-se dizer que o HED ocorreu espontaneamente 5 . Alguns casos de HED espontâneo têm sido relatados, associados a doenças infecciosas (sinusites e otite média aguda) [5][6][7][8][9][10][11] , malformações vasculares da dura-máter 5,12,13 , distúrbios da coagulação 14,15 e metástases na calota craniana 16 . Neste artigo apresentamos dois casos de HED espontâneo, um deles associado a distúrbios da coagulação e o outro a pansinusite.…”

Multiple Epidural Hematomas: Systematic Lıterature Review and an Unusual Case Presentation

“…Akut epidural hematomlarda kanama genellikle arteriyel orijinli iken, subakut ve kronik süreçte görülen epidural hematomlar venöz orijinlidir (1,3). Travma dışında koagülopati, konnektif doku hastalıkları, artmış vasküler frajilite, enfeksiyon ve kranial invaziv girişimler gibi birçok farklı nedene bağlı olarak epidural hematomlar görülebilmektedir (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Epidural hematomlar genellikle travma tarafında ve tek taraflı görülmektedir.…”