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Case Reports
. 2017 Jan-Mar;12(1):47-50.
doi: 10.4103/1793-5482.144177.

Spontaneous extradural and subgaleal hematoma: A rare neurosurgical crisis of sickle cell disease

Sudhansu S Mishra  1 , Satya B Senapati  1 , Amiya K Gouda  1 , Sanjay K Behera  1 , Ashis Patnaik  1
Affiliations
Case Reports

Spontaneous extradural and subgaleal hematoma: A rare neurosurgical crisis of sickle cell disease

Sudhansu S Mishra et al. Asian J Neurosurg. 2017 Jan-Mar.

Abstract

Extradural hematoma (EDH) in absence of trauma is a rare entity with only few cases reported in literature. The various causes reported include: Vascular malformation of dura, coagulopathies, sinus infection, middle ear or orbital infection, and tumor. Occurrence of spontaneous EDH as a complication of sickle cell disease is even much rarer. We report a case with sickle cell disease who presented with spontaneous extradural and subgaleal hematomas following an episode of vaso-oclusive crisis. He was managed successfully with surgery. The association of epidural hematomas in sickling hemoglobinopathies is reviewed. In all cases, we noticed one episode of sickle cell crisis just before the occurrence of spontaneous EDH. Perhaps this crisis puts an extra demand over the hematopoietic skull tissue disrupting inner and outer skull margins leading to spontaneous EDH and subgaleal hematoma.

Keywords: Sickle cell disease; skull infarctions; spontaneous extradural hematomas.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Arrow showing subgaleal hematoma over Lt Posterior parietal area
Figure 2
Figure 2
Axial CT scan of head shows Rt parietal heterogeneously hypodence biconvex extradural lesion
Figure 3
Figure 3
Bone window in CT scan showing increased marrow proliferation with thin cortical bone margins
Figure 4
Figure 4
X-ray skull showing increased marrow proliferation with thin cortical bone margins
Figure 5
Figure 5
X-ray skull showing break in continuity of inner skull margin
Figure 6
Figure 6
Trephine craniotomy showing altered blood and its degraded product in extra dural space
Figure 7
Figure 7
Craniotomy bone clearly showing increased hematopoietic skull tissue Proliferation with thin cortical bone margin
Figure 8
Figure 8
Inner surface of Craniotomy bone showing papery thin cortex with areas of Blackish discoloration and pinpoint bleeding sitesdischarged
Figure 9
Figure 9
Histo pathological examination of a bone piece reviled hyper-proliferative bone marrow
Figure 10
Figure 10
CT scan after 3 months of surgery at the time of follow up, showing previous craniotomy site with normal brain scan
See this image and copyright information in PMC

References

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