TRAVMATÝK GECÝKMÝÞ EPÝDURAL HEMATOMLAR: 7 YENÝ OLGU VE LÝTERATÜRDE RAPOR EDÝLMÝÞ 48 OLGUNUN RETROSPEKTÝF ANALÝZÝ

Posttravmatik gecikmiþ epidural hematomlarýn patogenezi tartýþmalýdýr. Bu çalýþmada 7 yeni olgu sunulmuþ ve daha önceden rapor edilmiþ 48 olgu gözden geçirilmiþtir. Kliniðimizde 7 yýllýk bir period süresince 74 epidural hematom olgusu arasýnda 7gecikmiþ epidural hematom olgusu saptandý. 5 olgu erkek (%71.4), 2 olgu bayan olup (%28.5) yaþ ortalamasý 16.7 yýldý (yaþ aralýðý: 11-21). Kabul sýrasýnda bir olgu hariç, Glasgow Koma Ölçeði puanlamalarý 11 ve daha üstündeydi. 6 olguda (%85.7) gecikmiþ hematoma komþu alanda fraktür mevcuttu. Hematomlarýn hiç biri ilk bilgisayarlý tomografi tetkikinde mevcut deðildi. Hematomlar travma sonrasý 3. Saat ve 6. günler arasýnda ortaya çýktý, ve en sýk karþýlaþan lokalizasyon frontal bölgeydi. 7 olgunun 3'ünde servikal travma mevcuttu. Hastaneye yatýþlarý ile gecikmiþ hematomun saptanmasý arasýndaki sürede 2 hastanýn nörolojik durumunda deðiþine olmadý, 3 hastada bozulma, 2 hastada düzelme oldu. 5 olgu opere edildi. Serimizde mortalite oraný %14.2 idi. Bize göre, beyin pulsasyonu ve kranial fraktür bu hematomlarýn patogenezindeki en önemli etyolojik faktörlerdir. Gecikmiþ epidural hematomlarýn tanýsý yüksek oranda þüpheyi ve tekrarlayýcý bilgisayarlý tomografik tetkikleri gerektirir. Nörolojik durumda bozulma tek baþýna güvenilir bir taný kriteri deðildir.

TRAUMATIC DELAYED EPIDURAL HEMATOMAS: 7 NEW CASES AND THE RETROSPECTIVE ANALYSIS OF 48 REPORTED CASES IN THE LITERATURE

The pathogenesis of posttraumatic delayed epidural hematoma formation is controversial. In this study, 7 new cases were presented and 48 previously reported cases were reviewed. In our clinic, seven cases of delayed epidural hematoma were found among 74 patients with epidural hematoma during a seven-year period, Five were male (71.4 %), two were female (28.5 %), with a mean age of 16.7 years (range =11-21). All but 1 Glasgow Coma Scores were 11 or greater on admission. There were skull fractures at the site of delayed hematoma in 6 patients (85.7%). None of these hematomas were present on initial computed tomography scans. The hematomas appeared between 3 hours and 6 days after the trauma, and the most common localization was the frontal region. Of the 7 patients, 3 had cervical trauma. 2 patients remained neurologically unchanged between admission and delayed epidural hematoma detection,3 deteriorated, and 2 improved. 5patients were operated upon. The mortality rate was 14.2 %. In our opinion, skull fracture,and the brain pulsations are the most important etiologic factors in the pathogenesis of these hematomas. Diagnosis of delayed epidural hematomas requires a high index of suspicion and repetetive computed tomography scans. Neurological deterioration alone is not a reliable diagnostic criteria.