Langerhans' cell histiocytosis presenting with an intracranial epidural hematoma

Abstract

An 8-year-old boy developed vomiting and severe headache following minor head trauma. A CT scan of the head demonstrated a lytic lesion of the skull and adjacent epidural hematoma. Surgical evacuation and removal of the skull lesion and hematoma were carried out, and pathologic evaluation resulted in a diagnosis of Langerhans' cell histiocytosis (LCH). Epidural involvement of Langerhans' cell histiocytosis is very rare, and we report the first case of LCH presenting as an intracranial epidural hematoma.

Eosinophilic Granuloma of Skull with Fluid Level and Epidural Hematoma: A Case Report and Review of the Literature

“…EG of the skull with EDH is extremely rare and has been reported in only 9 cases [5,6,7,8,9,10,11,12,13]. …”

“…Incidentally, 2 of these cases had sustained repeat trauma over the swelling due to a fall in the hospital followed by neurological deterioration [10,12]. Of the total 9 cases, 6 were in the occipital bone, and of these 3 had progressive neurological deterioration [8,9,11] as the EDH was extending from the occipital to the suboccipital region causing mass effect in the posterior fossa.…”

Cranial unifocal Langerhans cell histiocytosis in children

“…Solitary lesions may also be asymptomatic and incidentally discovered on a skull x-ray. However, acute presentation of a solitary EG with an epidural hematoma has been described [5,6]. The causes of epidural hematoma in these cases were suggested to be a rupture of the tumor cyst communicating with the epidural vein and the sinus pericranii and intratumoral bleeding rupturing into the epidural space [4].…”

Rapid Growing Eosinophilic Granuloma in Skull after Minor Trauma

“…There have been six reported cases of EG associated with epidural hematoma ( Table 1 ). 1 6 7 8 9 10) The possible mechanisms of epidural hematomas in the six cases consisted of a rupture of the tumor cyst, communicating with the epidural vein and the sinus pericranii, or a head trauma-related intratumoral hemorrhage, which subsequently penetrated into the epidural space. However, the two theories could not be applied in our case.…”