Hematoma epidural espontâneo: relato de dois casos

Abstract

RESUMO -Os hematomas epidurais espontâneos são raramente descritos na literatura. Estão associados a doenças infecciosas do crânio, distúrbios da coagulação, malformações vasculares da dura-máter e metástases na calota craniana. Os autores relatam dois casos de hematomas epidurais espontâneos de diferentes etiologias e discutem aspectos relacionados à hemostasia.PALAVRAS-CHAVE: hematoma epidural, hematoma espontâneo, hemostasia. Spontaneous epidural hematoma: report of two casesABSTRACT -Spontaneous epidural hematomas are rarely described in literature. They are associated with infectious diseases of the skull, coagulation disorders, vascular malformations of the dura-mater and metastasis to the skull. The authors report two cases of spontaneous epidural hematoma of different etiologies, and study parameters of hemostasis.KEY WORDS: epidural hematoma, spontaneous hematoma, hemostasis.Os hematomas epidurais (HED) são considerados lesões secundárias a traumatismo craniencefálico e sua incidência varia de 0,2 a 30% de acordo com a literatura 1-3 . Cerca de 83 a 95% dos casos estão associados a fraturas de crânio 2-5 ; 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) 5-11 , 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. Aspectos etiológicos dos HED espontâneos são discutidos. RELATO DOS CASOSCaso 1 -LA, 12 anos, sexo feminino, com insuficiência renal crônica devida a infecções urinárias de repetição, por bexiga neurogênica secundária a mielomeningocele corrigida no primeiro dia de vida. Foi submetida a transplante renal, houve moderada perda sanguínea, recebendo cerca de 400 ml de concentrado de hemácias no intra-operatório. Após o transplante foi mantida em UTI; no 3º dia pós-operatório, sem qualquer história de trauma, tornou-se irritadiça com cefaléia intensa na região parietal direita.

Nontraumatic Intracranial Epidural Hematoma: Systematic Review of the Literature

“…Spontaneous EDH is associated with four etiological categories 1 4 5 : pericranial infections, dural vascular malformations, skullcap metastasis, and coagulation disorders. In the present study, we observed other infrequent etiologies: eosinophilic granuloma, 8 9 10 11 12 13 14 kidney disease, 4 5 15 16 17 associated with drug therapy, 16 18 19 systemic lupus erythematosus, 20 21 cardiac surgery, 22 historical crying, 23 intracranial hypotension, 24 and intradiploic epidermoid cyst. 25 Hassan et al 26 suggest that the term nontraumatic is more appropriated than spontaneous to refer to EDH because this kind of EDH is invariably associated with a primary cause.…”

“…Among the reports with ocular involvement, the most common sign among the patients was periorbital edema (38.9%), 3 28 29 30 31 35 38 anisocoria, 3 40 exophthalmos (11.1%), 31 38 and papilledema (1%). 4…”

“…Among the reports with ocular involvement, the most common sign among the patients was periorbital edema (38.9%), 3,28,29,30,31,35,38 anisocoria, 3,40 exophthalmos (11.1%), 31,38 and papilledema (1%). 4 Spennato et al 38 reported the following data in a series of cases with pericranial infections: the mean age observed was 20 years old, most common in males (8:2), and frontal location EDH was the most frequent. These data were similar to the findings of Cho et al 37 In Asia, case reports of spontaneous EDH associated with sinus infections were more frequent due to the higher incidence of chronic pericranial infection cases among Asians.…”

“…Dural vascular malformations rarely lead to hematoma formation, but when they occur, they can be seen in the epidural space. 4…”

“…Spontaneous EDH is typically associated with four etiological categories: pericranial infections, dural vascular malformations, cranial metastases, and coagulation disorders. 4,5 The present study is a systematic review of the literature that aims to identify, compile, and analyze the case reports on EDH of a nontraumatic cause.…”