Post extradural haematoma evacuation infarcts: Analysis of 19 patients

Abstract

Over a 6-year period, of 1258 patients were operated for supratentorial extradural haematoma in our institution. Sixty patients died, 19 of these had cerebral infarcts in the postoperative period. This study analyses various parameters of these 19 patients to prognosticate the outcome. Factors such as age, gender, pupillary asymmetry, GCS (post resuscitation), infarcts etc are analysed. All patients were operated for supratentorial extradural haematoma. All of them had pre- and post-operative CT scan of head. All patients in this series had GCS less than 8. The average volume of extradural haematoma in this series was 77 ml and most of the haematomas were in the temporoparietal region. The infarcts were in middle cerebral, anterior cerebral, or internal carotid artery territory in 9 patients, 7 had features of infarcts involving more than one vascular territory. In addition, seven patients had posterior cerebral artery infarct. Mean time interval between injury and first scan was five hours, and between injury and second scan was 19 hours. We hypothesise that large extradural clot with the dural dissection could have caused intimal damage leading to infarct. We conclude that along with factors such as admission GCS, associated lesions such as sub-dural haematoma and contusion, cerebral infarcts are an important predictor of grave outcome in extradural haematoma patients.

Keywords

• cerebral infarcts
• extradural haematoma
• head injury
• mortality