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Research ArticleBrain

Follow-up of Conservatively Managed Epidural Hematomas: Implications for Timing of Repeat CT

Thomas P. Sullivan, Jeffrey G. Jarvik and Wendy A. Cohen
American Journal of Neuroradiology January 1999, 20 (1) 107-113;
Thomas P. Sullivan
aFrom the Department of Radiology, University of Washington Medical Center, 1959 NE Pacific St, 357115, Seattle, WA 98195.
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Jeffrey G. Jarvik
aFrom the Department of Radiology, University of Washington Medical Center, 1959 NE Pacific St, 357115, Seattle, WA 98195.
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Wendy A. Cohen
aFrom the Department of Radiology, University of Washington Medical Center, 1959 NE Pacific St, 357115, Seattle, WA 98195.
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    fig 1.

    Graph of RTS subgroups in patients (enlarging EDH under conservative management) and control subjects (stable EDH). Note that a higher RTS indicates less severe injury, and an RTS of 4 indicates an intubated and paralyzed patient

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    fig 2.

    Unenhanced CT scans of a 36-year-old male assault victim (initial CT scan 2 hours after injury).

    A and B (at a level 5 mm contiguously higher than A), Scans show a left temporal EDH, 2 cm in width. The patient was neurologically normal at the time of the initial CT scan.

    C and D (at a level 5 mm contiguously higher than C), Follow-up scans 10 hours later, after decline in neurologic status prompted repeat scanning. The EDH enlarged to 3 cm in width, associated with early ipsilateral uncal herniation. The patient underwent surgical evacuation and was discharged to a skilled nursing facility after a 17-day hospitalization.

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    fig 3.

    Unenhanced CT scans of an 87-year-old woman struck by a car (initial CT scan 2 hours after injury).

    A and B (at a level 15 mm higher than A), Scans show a 12-mm-wide high-right-convexity EDH with subarachnoid hemorrhage in the right parietal lobe inferiorly. The patient had a neurologic deficit, but surgery was not performed because of the patient's religious preferences. A further decline in neurologic status prompted a follow-up scan 9 hours later.

    C and D (at a level 10 mm higher than C), Scans show an increase in width of the high-right-convexity EDH to 18 mm, with ipsilateral parenchymal hemorrhage and severe right to left midline shift. The patient did not survive the injury.

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    TABLE 1:

    Comparison of clinical data for patients with enlarging epidural hematoma (EDH) (patient group) and those with stable EDH (control group)

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    TABLE 2:

    Comparison of imaging features for patients with enlarging epidural hematoma (EDH) (patient group) and those with stable EDH (control group)

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    TABLE 3:

    Comparison of neurologic status at discharge as measured by disposition

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American Journal of Neuroradiology
Vol. 20, Issue 1
1 Jan 1999
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Cite this article
Thomas P. Sullivan, Jeffrey G. Jarvik, Wendy A. Cohen
Follow-up of Conservatively Managed Epidural Hematomas: Implications for Timing of Repeat CT
American Journal of Neuroradiology Jan 1999, 20 (1) 107-113;

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Follow-up of Conservatively Managed Epidural Hematomas: Implications for Timing of Repeat CT
Thomas P. Sullivan, Jeffrey G. Jarvik, Wendy A. Cohen
American Journal of Neuroradiology Jan 1999, 20 (1) 107-113;
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