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Vol. 25. Num. 3.May - June 2014
Pages 99-148
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Vol. 25. Num. 3.May - June 2014
Pages 99-148
Case Report
DOI: 10.1016/j.neucir.2013.08.003
Non-traumatic spontaneous acute epidural hematoma in a patient with sickle cell disease
Hematoma epidural agudo espontáneo no traumático en una paciente con enfermedad de células falciformes
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Yurdal Serarslana,??
Corresponding author
, Mustafa Arasa, Murat Altaşa, Hasan Kayab, Boran Urfalıa
a Mustafa Kemal University, Tayfur Ata Sökmen Medical Faculty, Department of Neurosurgery, Hatay, Turkey
b Mustafa Kemal University, Tayfur Ata Sökmen Medical Faculty, Department of Haematology, Hatay, Turkey
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Abstract

A 19-year-old female with sickle cell anemia (SCD) was referred to our hospital after two days of hospitalization at another hospital for a headache crisis. This headache crisis was due to a raised intracranial pressure; these symptoms were noted and included in her comprehensive list of symptoms. There was an acute drop in the hemoglobin and hematocrit levels. The cranial CT scan demonstrated a left fronto-parietal acute epidural hematoma (AEH) and a calvarial bone expansion, which was suggestive of medullary hematopoiesis. The patient underwent emergent craniotomy and evacuation of the hematoma. There were no abnormal findings intra-operatively apart from the AEH, except skull thickening and active petechial bleeding from the dural arteries. Repeated CT scan showed a complete evacuation of the hematoma. The possible underlying pathophysiological mechanisms were discussed. In addition to the factors mentioned in the relevant literature, any active petechial bleeding from the dural arteries on the separated surface of the dura from the skull could have contributed to the expanding of the AEH in our patient. Neurosurgeons and other health care providers should be aware of spontaneous AEH in patients with SCD.

Keywords:
Epidural hematoma
Mechanism
Pathophysiology
Sickle cell
Sickle cell disease
Spontaneous epidural hematoma
Resumen

Una mujer de 19 años con anemia de células falciformes (anemia drepanocítica) fue remitida a nuestro hospital tras 2 días de hospitalización en otro centro, debido a una crisis de migraña. Dicha crisis de migraña fue debida a un incremento de la presión intracraneal; se anotaron dichos síntomas y se incluyeron en su amplia lista de síntomas. Se produjo un pico agudo en los niveles de hemoglobina y de hematocrito. El escáner craneal mostró un hematoma epidural agudo fronto-parietal izquierdo y una expansión del hueso de la bóveda craneal, que indicaba una hematopoyesis medular. Se sometió a la paciente a una craneotomía de urgencia y a una evacuación del hematoma. Aparte de la anemia de células falciformes, los hallazgos intraoperatorios fueron: adelgazamiento craneal y petequia activa de las arterias durales. La repetición del escáner mostró la evacuación total del hematoma. Se analizaron los posibles mecanismos patofisiológicos subyacentes. Además de los factores mencionados en la literatura relevante, cualquier sangrado petequial activo de las arterias durales sobre la superficie separada de la duramadre, desde el cráneo, podría haber contribuido a la expansión del hematoma epidural agudo en nuestra paciente. Los neurocirujanos y demás facultativos sanitarios deberían tener conocimiento del hematoma epidural agudo espontáneo en pacientes con anemia de células falciformes.

Palabras clave:
Hematoma epidural
Mecanismo
Patofisiología
Célula falciforme
Enfermedad de las células falciformes
Hematoma epidural espontánea

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