Non-traumatic spontaneous acute epidural hematoma in a patient with sickle cell disease

Serarslan Y., Aras M., Altas M., Kaya H., Urfali B.

NEUROCIRUGIA, vol.25, no.3, pp.128-131, 2014 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 25 Issue: 3
  • Publication Date: 2014
  • Doi Number: 10.1016/j.neucir.2013.08.003
  • Journal Name: NEUROCIRUGIA
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.128-131
  • Keywords: Epidural hematoma, Mechanism, Pathophysiology, Sickle cell, Sickle cell disease, Spontaneous epidural hematoma, SKULL INFARCTION, THALASSEMIA, PROPTOSIS, ANEMIA
  • Akdeniz University Affiliated: Yes


A 19-year-old female with sickle cell anemia (SCD) was referred to our hospital after two days of hospitalization at another hospital for a headache crisis. This headache crisis was due to a raised intracranial pressure; these symptoms were noted and included in her comprehensive list of symptoms. There was an acute drop in the hemoglobin and hematocrit levels. The cranial CT scan demonstrated a left fronto-parietal acute epidural hematoma (AEH) and a calvarial bone expansion, which was suggestive of medullary hematopoiesis. The patient underwent emergent craniotomy and evacuation of the hematoma. There were no abnormal findings intra-operatively apart from the AEH, except skull thickening and active petechial bleeding from the dural arteries. Repeated CT scan showed a complete evacuation of the hematoma. The possible underlying pathophysiological mechanisms were discussed. In addition to the factors mentioned in the relevant literature, any active petechial bleeding from the dural arteries on the separated surface of the dura from the skull could have contributed to the expanding of the AEH in our patient. Neurosurgeons and other health care providers should be aware of spontaneous AEH in patients with SCD. (C) 2013 Sociedad Espanola de Neurocirugia. Published by Elsevier Espana, S.L. All rights reserved.