PubMed · 8592245
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D Foo. 1996. Spinal epidural hematoma.. https://doi.org/10.3171/jns.1996.84.2.0308
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Epidural haematoma in newborn infants is rare, and few specific obstetrical data related to its formation are available in the literature. The aim of this study is to discuss the pathophysiology of this condition. EDH is always a post traumatic lesion and it is only possible if the insult has produced a cleavage of the dura mater from bone. Therefore, EDH results from the mechanical forces exerted on the foetal head during birth, with or with no instrumental interference. Although it is still unclear whether the injury (and dura mater cleavage) was directly caused by the forceps or had already been inflicted by natural forces, or a combination of both however, in some patients (with neither dystocia nor skull fracture), there is no basis for explaining EDH formation, apart from propulsion of the fore coming head through the birth canal. Excessive moulding, whether or not associated with iatrogenic trauma, has been incriminated in most cases of EDH. As dystocia cannot always be anticipated, EDH will remain an ever-present cause of morbidity in the neonatal population, albeit a rare occurrence.
Paget's disease of skull usually causes neurological complications such as basilar invagination, cranial neuropathies, etc. Occurrence of extradural hematoma in association with Paget's disease of skull is rare. A 48 year old man presented with headache and right upper limb weakness, two days after a fall from scooter. CT Scan of brain showed a large extradural hematoma at the vertex with the cranial vault showing features of Paget's disease. At surgery, no skull fracture or injury to the superior sagittal sinus was evident. There was diffuse oozing from the inner table of the skull, which showed features of Paget's disease. The extradural hematoma was evacuated and the patient made good recovery. He deteriorated a few hours after surgery. Follow up CT Scan showed diffuse brain swelling with minimal recollection of hematoma. Re-exploration showed a small recollection which was evacuated and the part of the oozing diseased skull was excised. The patient recovered completely. This is the first reported case of vertex extradural hematoma in association with the Paget's disease of skull. The unusual features are the absence of skull fracture and injury to the superior sagittal sinus. The increased vascularity of the skull due to Paget's disease has caused the hematoma by diffuse oozing from the inner table.
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