Epidural haematoma. A retrospective study of 100 patients.

A retrospective study was made of 100 consecutive patients with an epidural haematoma in order to establish which clinically demonstrable factors had influenced the prognosis quoad vitam et sanationem. Operations were performed on 92 of these patients, 29 (32%) of whom died; 8 patients died without operation, and in 2 of these cases the diagnosis was not made during life. A lucid interval was observed in 57 patients; absence of a lucid interval in combination with a lowered sensory level indicated associated intradural lesions (cerebral contusion, acute subdural haematoma), with consequently a less good prognosis. The prognosis was also adversely affected by deeper coma, occurrence of extensor spasms, bilateral stiff pupils, bilateral pyramidal symptoms and an age over 50. Some 33% of the patients treated by operation showed marked symptoms of compression (extensor spasms and/or bilateral stiff pupils); although these symptoms are usually described as indicative of a hopeless prognosis, 40% of the patients in this catagory survived. Contrary to the data in the literature, the interval between accident and operation within the first 24 hours did not influence the mortality, which was 50%. All patients operated on more than 24 hours after the accident, survived. A cranial fracture was absent in 13 patients, 11 of whom were under 30; absence of a cranial fracture was prognostically favourable. A catamnestic study revealed that 7 of the 58 accessible survivors had residual neurological dysfunctions; all these patients were up and about. The residual morbidity after early operation (within 24 hours) was the same as that after later operation. The data obtained were compared with those on a number of series recently published in the literature.