Acute clinical deterioration of posterior fossa epidural hematoma: clinical features, risk factors and outcome.
BACKGROUND
This study aimed to present experience in treating patients with posterior fossa epidural hematoma (PFEDH) and to discuss the risk factors, clinical features, and outcome in PFEDH patients with acute clinical deterioration (ACD).


METHODS
Twenty-seven patients with PFEDH initially treated conservatively were evaluated. A comparison was made between patients with and without ACD during hospitalization.


RESULTS
Eight of the 27 patients subsequently experienced ACD. Local traumatic findings, loss of consciousness due to injury, headache, and vomiting were the four most common clinical features of the 27 cases. Seven of the 8 patients with ACD had good recoveries and 1 died. Eighteen of the 19 patients without ACD had good recoveries, while 1 remained moderately disabled. Stepwise logistic regression demonstrated that the adjusted risk of ACD during hospitalization for patients with vomiting and an occipital fracture across the transverse sinus on computed tomography (CT) had odds ratios of 12.6 (95% confidence interval = 1.03-152.37, p = 0.047) and 8.8 (95% CI = 1.02-75.95, p = 0.048), respectively, compared with those without ACD.


CONCLUSIONS
This study demonstrated that an occipital fracture across the transverse sinus on CT and vomiting on presentation are risk factors for ACD during hospitalization. In this study, PFEDH patients including those with ACD had good outcomes. Further studies are necessary to clarify the clinical course and risk factors for the clinical deterioration of PFEDH patients and to establish a treatment strategy.
Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Taiwan.
Tsung-Ming
TM
Su
Tsung-Han
TH
Lee
Tao-Chen
TC
Lee
Ching-Hsiao
CH
Cheng
Cheng-Hsien
CH
Lu
D000328:Adult; D003388:Cranial Fossa, Posterior / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D015600:Glasgow Coma Scale; D006407:Hematoma, Epidural, Cranial / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014839:Vomiting; D055815:Young Adult