Rapidly Calcifying and Ossifying Epidural Hematoma

Abstract

Conservative treatment of an epidural hematoma is not always effective in children. We describe an 8-year-old boy who had been followed up conservatively for 10 days at a local hospital due to acute epidural hematoma. A new CT revealed an expansion of the former hematoma accompanied by a thick hyperdense layer. Because the patient presented with symptoms of elevated intracranial pressure, an immediate craniotomy was performed to evacuate the hematoma. The ossified layer, which was densely adhered to the dura mater, was also completely removed. Rapid ossification and/or calcification of an epidural hematoma appearing 10 days after a head injury have not been reported previously. Possible mechanisms of rapid ossification are also discussed in relation to the present report, and the relevant literature is reviewed.

Ossified Epidural Hematoma

“…The pathogenesis of calcification in the intracranial hematoma remains unclear. The possible mechanism of ossification of the hematoma may be that the clot underwent fibrous organization and microscopic ossification, and the dura further aggravated ossification (1). For children, conservative treatment is often indicated in patients with mild symptoms due to EDH.…”

Serial CT Findings of a Rapidly Calcified Epidural Hematoma in a Young Adult: A Case Report

“…The precise mechanism of this calcification is poorly understood. Damage to vascularized tissues has been postulated to provoke tissue responses, including inflammation, repair, and remodeling . This natural sequence of healing is more rapid in children .…”

“…Nagane et al reported incidental findings of a calcified EDH 40 years after head injury. In contrast, Erdogan et al reported rapid ossification of an EDH appearing in an 8‐year‐old boy 10 days after head trauma. Ossified EDHs have also occurred after decompressive brain surgery, and after ventriculoperitoneal shunt insertion .…”

“…This condition often causes complications as it may prevent spontaneous absorption of EDH . A mass effect due to rapid EDH calcification can cause neurologic deterioration . Here, we report the case of a 21‐year‐old woman with a right frontal calcified EDH that was detected by serial computed tomography (CT) 17 days after head trauma.…”

“…Calcification or ossification of a chronic epidural hematoma (EDH) has been reported in several studies . Nagane et al reported incidental findings of a calcified EDH 40 years after head injury.…”