Posterior fossa epidural hematomas: a review and synthesis

Abstract

The authors report three patients with posterior fossa epidural hematomas and analyze 80 additional cases in the accessible literature. They occur in the younger age groups with a clear male predominance (3.6 to 1). The loss of consciousness at the time of impact and just before surgical intervention have both proved to be factors indicating a poor prognosis. The clinical symptoms and signs were classified in three general types: increased intracranial pressure, brainstem dysfunction, and cerebellar disturbances. A fracture of the occipital bone was seen in 84.2% of the patients. The source of bleeding often remained undetermined, although a tear of the dural sinuses was a most frequent finding. An associated intracranial lesion was found in 39.7% of the cases, this being another factor indicating a poor prognosis. The overall mortality was 26.5%, while the surgical mortality was only 11.5%. Excellent results were achieved in 65% of the cases.