Traumatic posterior fossa hematomas.
PURPOSE: Posterior fossa epidural hematomas are much less common than supratentorial epidural hematomas. The incidence of posterior fossa epidural hematomas among intracranial epidural hematomas has been reported to be 4% to 7%. Seven cases of posttraumatic posterior fossa epidural hematomas diagnosed by computed tomography (CT) are reported with radiological and clinical findings. MATERIALS AND METHODS: This study consisted of 7 posterior fossa epidural hematoma cases, out of 585 severe head trauma patients admitted and hospitalized in an 18-month period. The patients were evaluated regarding age, gender, type of trauma, cranial CT and Glasgow coma score in admittance, treatment and follow-up. RESULTS: Average age was 24.2 years and 85.7% of the cases were male. All cases had occipital fracture. Fifty-seven percent of the cases had only occipital fracture and posterior fossa epidural hematoma. All of the cases in this group were neurologically intact except for one who had a Glasgow coma score of 9 in admission. Two cases of this group were conservatively treated. In the others posterior fossa epidural hematomas got larger and they were treated surgically; these two cases recovered after surgery. Three of the 7 cases had the supratentorial region lesions; one of these cases died before operation. Two of them were treated surgically, one of them died and the other showed recovery after surgery. CONCLUSION: Acute posterior fossa epidural hematomas are usually symptom-free initially. After this silent period, clinical deterioration is quick to become fatal in most of patients. Surgery can be life-saving when performed in a timely manner. Therefore, CT should always be performed when an occipital trauma is diagnosed.