Cranial epidural hematomas: A case series and literature review of this rare complication associated with sickle cell disease

Abstract

Although rare, cranial epidural hematoma can be fatal and should be considered in patients with acute neurological symptoms.

Iliopsoas hematoma in a patient with sickle cell disease

“…Evaluation and management should be focused on assessing the volume and rate of hemorrhage with frequent monitoring of blood counts and a low threshold for transfusion or intervention. Coagulation abnormalities reported in prior case series of craniofacial PH include prolonged PT and thrombocytopenia, neither of which is present here. Although a concurrent mild bleeding disorder remains possible, our patient's normal PT/PTT combined with a lack of further bleeding symptoms argues against the diagnosis.…”

“…Previous reports of spontaneous PH in SCD have been limited to craniofacial bones, resulting in epidural and/or retro‐orbital hemorrhage. Spontaneous epidural hematomas have been well characterized as a rare complication within the spectrum of central nervous system manifestations of SCD . Retro‐orbital hematomas resulting in orbital compression syndrome have also been described, both in isolation and concurrently with epidural hematomas .…”

“…The pathophysiology underlying PH remains a subject of debate. MRI frequently identifies areas of bone infarction adjacent to the hematoma . The majority of reports have therefore implicated bone infarcts as a precipitating event.…”

“…Bleeding complications, other than hemorrhagic stroke, are rare. However, craniofacial periosteal hematomas (PH), thought to be precipitated by acute bone infarcts, represent an increasingly recognized and serious hemorrhagic complication of SCD . We present an unusual case of hip pain due to iliacus hematoma secondary to bone infarction in a patient with SCD and elaborate on the role of bone infarction in the development of PH.…”

“…However, craniofacial periosteal hematomas (PH), thought to be precipitated by acute bone infarcts, represent an increasingly recognized and serious hemorrhagic complication of SCD. [3][4][5][6] We present an unusual case of hip pain due to iliacus hematoma secondary to bone infarction in a patient with SCD and elaborate on the role of bone infarction in the development of PH. uation demonstrated a white blood count of 10,100/ l, hemoglobin 8.9 g/dl (baseline 9-10 g/dl), hematocrit 26%, and platelets 454,000/ l. C-reactive protein (CRP) was elevated at 15.8 mg/dl (reference range 0-0.9 mg/dl).…”