Sullivan T P, Jarvik J G, Cohen W A
Department of Radiology, University of Washington Medical Center, Seattle 98195, USA.
AJNR Am J Neuroradiol. 1999 Jan;20(1):107-13.
Small asymptomatic epidural hematomas (EDHs) are frequently managed nonoperatively with good neurologic outcome. Our goals were to determine the frequency and timing of enlargement of acute traumatic EDHs that are not immediately surgically evacuated as well as to identify factors associated with rehemorrhage.
Of 252 consecutive patients with acute traumatic EDH who were treated over a 5-year period, 160 were managed nonoperatively. Their CT scans, imaging reports, and medical records were reviewed retrospectively. Parameters analyzed as possible predictors of rehemorrhage during nonoperative management were size of the EDH, presence of an associated fracture, contralateral brain injury, midline shift, coagulopathy, and neurologic and physiological injury as measured by the Revised Trauma Score. We compared discharge discharge disposition as a proxy for neurologic condition at discharge.
The EDH enlarged in 37 (23%) of the 160 patients during conservative management. Mean enlargement was 7 mm, and the mean time to enlargement was 8 hours after injury and 5.3 hours after CT diagnostics. EDH enlargement occurred within 36 hours after injury in all cases. Of the parameters analyzed, only a high Revised Trauma Score correlated significantly with EDH rehemorrhage, suggesting that intubation and chemical paralysis may prevent rehemorrhage through the restriction of head movement and the control of blood pressure. The subgroup of patients with rehemorrhage experienced no difference in neurologic outcome despite a higher rate of clinical deterioration.
EDH enlargement occurs frequently, but early. Repeat imaging with CT is most appropriate within 36 hours after injury.
小型无症状硬膜外血肿（EDH）通常采用非手术治疗，神经功能预后良好。我们的目标是确定未立即进行手术清除的急性创伤性EDH扩大的频率和时间，并识别与再出血相关的因素。
在5年期间连续治疗的252例急性创伤性EDH患者中，160例采用非手术治疗。对他们的CT扫描、影像报告和病历进行回顾性分析。分析作为非手术治疗期间再出血可能预测指标的参数包括EDH大小、是否存在相关骨折、对侧脑损伤、中线移位、凝血功能障碍以及通过修订创伤评分衡量的神经和生理损伤。我们将出院时的出院处置情况作为出院时神经状况的替代指标进行比较。
在保守治疗期间，160例患者中有37例（23%）的EDH扩大。平均扩大7mm，扩大的平均时间为受伤后8小时和CT诊断后5.3小时。所有病例的EDH扩大均发生在受伤后36小时内。在分析的参数中，只有高修订创伤评分与EDH再出血显著相关，这表明插管和化学麻痹可能通过限制头部运动和控制血压来预防再出血。尽管临床恶化率较高，但再出血患者亚组的神经功能预后并无差异。
EDH扩大经常发生，但时间较早。受伤后36小时内进行CT复查最为合适。
