Observations on 82 patients with extradural hematoma

Comparison of results before and after the advent of computerized tomography

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✓ A consecutive, unselected series of 82 patients with epidural hematoma treated between 1973 and 1980 is presented. Forty-one patients were managed before the advent of computerized tomography (CT) and the other 41 after this neuroradiological method was available. Mortality and disability rates which were 29.2% and 31.7% during the pre-CT period decreased to 12.1% and 19.5%, respectively, with the aid of CT scanning. This technique allowed a more rapid and accurate diagnosis of the hematomas than angiography, and defined better the presence and the evolutional changes of the associated cerebral lesions. As a consequence, surgery has been more effectively planned and executed during the CT era.

Article Information

Address reprint requests to: Francisco Cordobés, M.D., Department of Neurosurgery, Ministerio de Trabajo, Instituto Nacional de Prevision, Ciudad Sanitaria de la S.S., “1°- de Octubre,” Ctra. de Andalucia, Km. 5,400, Madrid, Spain.

© AANS, except where prohibited by US copyright law.

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Figures

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    Locations of the hematomas in this series. The large numbers indicate the total hematomas in each region, and the left and right smaller numbers underneath represent the hematomas observed during the pre-computerized tomography (CT) and CT periods, respectively. Ten patients had frontal clots, but one of them had a bilateral clot (asterisk).

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    Upper: Form of the epidural hematomas as seen by the computerized tomography (CT) scan, and its relative frequency. There were 31 double convex hematomas (asterisk represents a bilateral one), two bilenticular double convex, four single convex, and two irregular forms. Lower: Illustrations of the effect of the clots upon the ventricular system as seen by the CT scan. The crosses in these figures represent the number of deaths.

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    Left: Computerized tomography scan showing a bilenticular frontoparietal epidural hematoma. Right: Scan showing an irregular epidural hematoma which coexisted with a contralateral temporal contusion.

  • View in gallery

    Computerized tomography scans showing a small epidural clot in one patient with diffuse brain swelling (left), and controls performed 1 (center) and 7 (right) days after the evacuation of the hematoma.

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