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KMID : 0378019760190120073
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New Medical Journal
1976 Volume.19 No. 12 p.73 ~ p.82
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Clinical Observation on Pure Extradural Hematomas
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Abstract
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Of all the potentially lethal complications of head injury, extradural hematoma is the most readily diagnosed and remediable, yet the mortality rate remains distressingly high. The onset of deepening coma, especially a lucid interval, together with an enlarging pupil, contralateral hemiplegia, andd bradycardia all portray the wellknown picture of hemorrhage into the.:g6nial I extradural space. . In such cases, the diagnosis is usually established quickly, -and *her L, appropriate surgical measures are taken the prognosis will be fairly good.
Author presents here a series of 52 cases of pure extradural hematoma those were treated by surgically at Department of Neurosurgery, Kyung Hee University -Hospital during the period from. October, 1974 till April, 1976.
The results were as follows:
1) There was little significant difference in any decade but some preponderance of youth. Males outnumbered females by almost 4 to 1.
2) The common causes were road traffic accidents(58%), falls from height(27%), and direct blows to head.
3) Altered consciousness revealed about 86.5% of the total patients. Pupillary abnormalities. were seen in 37 patients (71.2%). Babinski´s sign and vomiting occured in 24 and 17 each cases. The lucid interval was found in 11 cases.
4) Of 37 cases with pupillary abnormalities, in 11 cases the pupils were anisocoric and fixed. In 8 cases the ipsilateral pupil was much dilated but the presence of light reflexes. In theremaining 13, various degrees of pupillary abnormalities were found.
5) In 51 cases with skull fracture, 50 was demonstrated by x-ray, 1 had no fracture by x-ray but the fracture was demonstrated by operation. 46 cases showed lineal fracture, while theremainder had depresed one. The location of skull fracture in order of frequency were temporal (16 Cases) and parietotemporal (15 cases) bone.
6) The interval between injury and operation was the greatest at 3 to 6 hours.
7) The site of origin of the extradural hemorrhage was observed to be arterial in 24 and ´venous in 11, in 12 it´ arose 11 :2, OtW artery´ and vein, the remaining 5 : the origin 1vas not determined.
8) The surgical morality ate fly q yes).. All those were operated within 24 hours after injury. There was na-correlatibn `between´ the ´´age´ and mortality but a good: correlation. between the deterioration of consciousness and mortality, of 16 cases in coma, 75% died. In 17 cases which site of origin of hemorrhage was both artery and vein, 6 died (37.5%). The surgical prognosis was very poor when the ´pupillary abnormalities were present; 16 cases manifested evidence of either bilaterally full dilated with fixed : pupils or anisocoric with fixed prior to operation and 56.3% died after operation.
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