Traumatic Posterior Fossa Extradural Haematoma

Abstract

Posterior fossa extradural haematoma is known for the vague signs and symptoms and a notorious
course that varies from recovery to sudden death. The incidence of posterior fossa epidural hematomas
among intracranial epidural hematomas has been reported from 4% to 7%. Subsequently, PFEDH
with low GCS or the haematoma of more than 10ml were subjected to evacuation. Since the volume
of the posterior fossa is limited, patients deteriorate early with the development of obstructive
hydrocephalus, which is visible in the CT scan in only thirty percent of cases.
A retrospective study of 43 cases was done in this Institute from May 1999 to December 2005. The
males (98%) have a clear predominance over female patients (2%). Road traffic accidents accounted
for the majority of the cases (80%), fall for the rest (17%) and one case due to a bullhorn injury.
Vomiting was the most common symptom accounting for 67% of cases followed by transient loss
of consciousness in 48% and headache in 34%. On arrival to the hospital 67% presented with a GCS
more than 13, 28% with score of 9-12 and the rest 5% with GCS of less than 8. Out of the total 43 cases
of PFEDH surgical evacuation was done in 33(76%) and conservative management in 10 cases (23%).
A dichotomised Glasgow outcome score was used to measure the outcome. This was favorable in
27 of the 33 cases operated (81%), and 7 out of the 10 conservatively managed group (70%). Overall
favorable outcome was found in 34 cases (79%) with overall mortality of the study being 7%.

Key words: extradural, haematoma, posterior fossa, trauma