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Leakage Sign Is a Reliable Predictor of Hematoma Expansion in Acute Epidural Hematoma.
Sugi, Keisuke; Kikuchi, Jin; Yoshitomi, Munetake; Orito, Kimihiko; Kajiwara, Sosho; Nakamura, Yukihiko; Takeshige, Nobuyuki; Takeuchi, Yasuharu; Abe, Toshi; Morioka, Motohiro.
Afiliación
  • Sugi K; Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan.
  • Kikuchi J; Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan.
  • Yoshitomi M; Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan.
  • Orito K; Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan.
  • Kajiwara S; Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan.
  • Nakamura Y; Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan.
  • Takeshige N; Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan.
  • Takeuchi Y; Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan.
  • Abe T; Department of Radiology, Kurume University School of Medicine, Kurume, Japan.
  • Morioka M; Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan. Electronic address: mmorioka@med.kurume-u.ac.jp.
World Neurosurg ; 189: e674-e680, 2024 Sep.
Article en En | MEDLINE | ID: mdl-38950651
ABSTRACT

BACKGROUND:

Hematoma expansion (H-Ex) in small-/medium-sized acute epidural hematoma (AEDH) cases upon emergency admission is critical. Predicting H-Ex can lead to early surgical interventions, improving outcomes, and eliminating the need to check for expansion via computed tomography (CT). This study aimed to identify the most reliable predictors of AEDH expansion.

METHODS:

We retrospectively collected data from patients with pure AEDH not requiring surgical treatment upon emergency admission from 2012 to 2022. We assessed clinical and laboratory data, time from injury to the first CT, and time to follow-up CT. Factors predictive of H-Ex on the second follow-up CT, including the leakage sign (LS), were analyzed.

RESULTS:

A total of 23 patients with pure AEDH without surgery at admission were included, and LS was positive in 18. Thirteen patients showed H-Ex. The H-Ex group showed a significantly higher rate of positive LS and a lower mean platelet count than the group without H-Ex. LS's predictive value for AEDH expansion showed 100% sensitivity and 50% specificity. All patients with negative LS and normal platelet counts showed no H-Ex. Analyzing the time from injury to the first CT suggested that LS (+) within 120 minutes strongly predicted H-Ex. Reconstructed three-dimensional images of the leakage point on the skull revealed multiple mottled bleeding points on the dural surface.

CONCLUSIONS:

LS can predict H-Ex in patients with pure AEDH for whom emergency surgery is unnecessary at admission. The time from injury and platelet counts must also be considered.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Tomografía Computarizada por Rayos X / Hematoma Epidural Craneal Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: World Neurosurg Asunto de la revista: NEUROCIRURGIA Año: 2024 Tipo del documento: Article País de afiliación: Japón Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Tomografía Computarizada por Rayos X / Hematoma Epidural Craneal Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: World Neurosurg Asunto de la revista: NEUROCIRURGIA Año: 2024 Tipo del documento: Article País de afiliación: Japón Pais de publicación: Estados Unidos