Traumatic posterior fossa extradural haematomas (PFEDH).
OBJECTIVE
While posterior fossa extradural haematomas (PFEDH) may lead to rapid neurological deterioration and death because of brainstem compression, prompt treatment often leads to a good outcome. The non-specific clinical signs and the rarity of this lesion in craniocerebral trauma adds to the difficulty in diagnosis. The aim of this study was to identify features which could lead to an early diagnosis.


METHODS
Seventeen patients with posterior fossa extradural haematomas were operated on over 4 1/2 years, accounting for 7.5% of the 226 surgically operated extradural haematomas in the Department of Neurosurgery, Tan Tock Seng Hospital, Singapore. Four patients were excluded from this study due to non-availability of the case records. The remaining 13 patients formed the study group in this retrospective analysis.


RESULTS
The majority of cases (77%) presented acutely within 24 hours. The mechanism of injury varied from a fall in 7 cases, a road traffic accident in 4 cases and assault in 2. Nine patients had evidence of external injury to the occiput, 8 patients had skull fractures, and diastasis of the lambdoid suture was seen in 2 cases. Presence of aerocele was noted in the CT scan of 4 cases. All 9 cases admitted with a high GCS score of more than 8 had a very good outcome.


CONCLUSIONS
An early CT scan head is recommended if a combination of the following features is present: occipital soft tissue injury, drowsiness, occipital fracture or diastasis of the lambdoid suture.
Wang
E C
EC
Department of Neurosurgery, Tan Tock Seng Hospital, Singapore.
Lim
A Y
AY
Yeo
T T
TT
D000058:Accidental Falls; D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000388:Air; D001933:Brain Stem / Q000293:injuries; D002648:Child; D002675:Child, Preschool; D003388:Cranial Fossa, Posterior / Q000293:injuries*; D003393:Cranial Sutures / Q000293:injuries; D005260:Female; D015600:Glasgow Coma Scale; D006407:Hematoma, Epidural, Cranial / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D009777:Occipital Bone / Q000293:injuries; D010294:Parietal Bone / Q000293:injuries; D012189:Retrospective Studies; D012887:Skull Fractures / Q000150:complications; D012894:Sleep Stages / Q000502:physiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014754:Violence