El desarrollo de un hematoma extradural contra-lateral durante la evacuación de un hematoma extraaxial de origen traumático es un hecho muy infrecuente. Generalmente se produce en pacientes con traumatismo craneoencefálico (TCE) grave en el que se aprecia un hematoma extraaxial y una fractura craneal contralateral. El rápido aumento de la tensión cerebral en el área operada tras la evacuación del hematoma inicial debe hacer sospechar el diagnóstico.
Presentamos el caso de un paciente con un TCE grave y un hematoma extradural durante cuya evacuación se produjo el desarrollo de un hematoma extradural contralateral. Su existencia fue sospechada debido al repentino aumento de la tensión cerebral durante la evacuación del primer hematoma y diagnosticado tras realización de tomografía computarizada craneal (TC) de emergencia.
La disminución de la presión intracraneal y la pérdida del efecto tampón tras la evacuación del hematoma inicial, se consideran los mecanismos patogénicos fundamentales en el desarrollo del hematoma contralateral.
The development of an extradural hematoma during the evacuation of a traumatic extracerebral hematoma is a very rare event. It occurs in patients with a severe head injury that present with both an extraaxial hematoma and a contralateral skull fracture. Recognition of the signiflcance of a sudden increase in the cerebral tension after hematoma evacuation is the key for a pront diagnosis of the development of a contralateral lesion.
We present the case of a patient with a severe head trauma and an extradural hematoma who developed a contralateral extradural hematoma during evacuation of the initial one. The development of a contralateral lesion was suspected by a sudden and unexpected increase in cerebral tension during evacuation of the flrst hematoma and conflrmed by emergency CT sean.
We think that the most important pathogene-tic mechanisms involved in the development of a contralateral extradural hematoma are the rapid fall of intracranial pressure, the loss of tamponade effect achieved by the energetic use of antiedema measures and the evacuation of the ipsilateral hematoma.
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