Advertisement
Case Report| Volume 16, ISSUE 6, P834-837, June 2009

Download started.

Ok

An atypical case of head trauma with late onset of contrecoup epidural hematoma, cerebellar contusion, and cerebral infarction in the territory of the recurrent artery of Heubner

      Abstract

      We encountered a case of head trauma with very unusual delayed events. A 68-year-old woman was admitted to our hospital after receiving a direct impact to her occiput in a traffic accident. Head CT scans showed a thin acute epidural hematoma in the posterior fossa corresponding to a linear fracture, followed by late onset of contrecoup left frontal epidural hematoma and subsequent cerebellar contusion in the right cerebellar hemisphere. Fifteen days after the trauma, the patient developed mild motor weakness of right upper extremity. MRIs demonstrated an infarct in the territory of the left recurrent artery of Heubner. Although rare, atypical late events in patients with head trauma as reported here should be taken into consideration during subacute follow-up periods.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Clinical Neuroscience
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Baratham G.
        • Dennyson W.G.
        Delayed traumatic intracerebral haemorrhage.
        J Neurol Neurosurg Psychiatry. 1972; 35: 698-706
        • Cassinari V.
        • Dorizzi A.
        • Pauli P.
        • et al.
        Expansive traumatic lesions of the posterior cranial fossa: On 4 cases of cerebellar contusion and laceration.
        Minerva Neurochir. 1967; 11: 230-239
      1. d’Avella D, Salpietro FM, Angileri FF, et al. Management of traumatic cerebellar hemorrhagic contusions and hematomas. Acta Neurochir Suppl 1998;71:410 (abstract).

        • d’Avella D.
        • Servadei F.
        • Scerrati M.
        • et al.
        Traumatic intracerebellar hemorrhage: clinicoradiological analysis of 81 patients.
        Neurosurgery. 2002; 50: 16-27
        • Hamasaki T.
        • Yamaki T.
        • Yoshino E.
        • et al.
        Traumatic posterior fossa hematomas.
        No To Shinkei. 1987; 39: 1083-1090
        • Karasawa H.
        • Furuya H.
        • Naito H.
        • et al.
        Acute hydrocephalus in posterior fossa injury.
        J Neurosurg. 1997; 86: 629-632
        • Koziarski A.
        • Frakiewich E.
        Medical and surgical treatment of intracerebellar hematomas.
        Acta Neurochir. 1991; 110: 24-28
        • Nagata K.
        • Ishikawa T.
        • Ishikawa T.
        • et al.
        Delayed traumatic intracerebellar hematoma: correlation between the location of the hematoma and the preexisting cerebellar contusion. Case report.
        Neurol Med Chir (Tokyo). 1991; 31: 792-796
        • Olin M.S.
        • Young H.A.
        • Schmidek H.H.
        Contrecoup intracerebellar hemorrhage: report of a case.
        Neurosurgery. 1980; 7: 271-273
        • Pozzati E.
        • Grossi C.
        • Padovani R.
        Traumatic intracerebellar hematomas.
        J Neurosurg. 1982; 56: 691-694
        • Pozzati E.
        • Piazza G.
        • Padovani R.
        • et al.
        Benign traumatic intracerebellar hematoma.
        Neurosurgery. 1981; 8: 102-103
        • Sakuta Y.
        • Sakuta Y.
        Traumatic acute intracerebellar hematoma. A case of complete recovery.
        No Shinkei Geka. 1980; 8: 1087-1092
        • Sato K.
        • Hinokuma K.
        • Matsuzawa Y.
        • et al.
        Clinical study of traumatic cerebellar contusion.
        No Shinkei Geka. 1987; 15: 1285-1289
        • Sato O.
        • Kuwabara T.
        • Nakamura N.
        On the traumatic hematoma of the posterior fossa.
        No To Shinkei. 1965; 17: 437-438
        • Satoh T.
        • Yamamoto Y.
        • Asari S.
        Traumatic acute intracerebellar hematoma: Especially the value of CT follow-up.
        No Shinkei Geka. 1983; 11: 101-106
        • Seida M.
        • Ito U.
        • Kito K.
        • et al.
        Traumatic cerebellar hematoma in children. Report of two cases.
        Neurol Med Chir (Tokyo). 1986; 26: 318-322
        • Shigemori M.
        • Shirahama M.
        • Tokutomi T.
        • et al.
        Delayed development of traumatic intracerebellar hematoma. Case report. Significance of serial CT can and management.
        Neurol Med Chir (Tokyo). 1981; 21: 427-431
        • Sokol J.H.
        • Rowed D.W.
        Traumatic intracerebellar hematoma.
        Surg Neurol. 1978; 10: 340-341
        • St John J.N.
        • French B.N.
        Traumatic hematomas of the posterior fossa: a clinicopathological spectrum.
        Surg Neurol. 1986; 25: 457-466
        • Tibbs P.A.
        • Goldstein S.J.
        • Smithson J.R.
        Delayed traumatic intracerebellar hematoma.
        Surg Neurol. 1981; 16: 309-311
        • Tsai F.Y.
        • Teal J.S.
        • Itabashi H.H.
        • et al.
        Computed tomography of posterior fossa trauma.
        J Comput Assist Tomogr. 1980; 4: 291-305
        • Vrankovoic D.
        • Splavski B.
        • Hecimovic I.
        • et al.
        Anatomical cerebellar protection of contrecoup hematoma development: Analysis of the mechanism of 30 posterior fossa coup hematomas.
        Neurosurg Rev. 2000; 23: 156-160
        • Wright R.L.
        Traumatic hematomas of the posterior cranial fossa.
        J Neurosurg. 1966; 25: 402-409
        • Yokota H.
        • Mizunari T.
        • Kuzuhara M.
        • et al.
        Traumatic delayed intracerebellar hematoma.
        Neurol Med Chir (Tokyo). 1988; 28: 886-890
        • Zuccarello M.
        • Andrioli G.C.
        • Fiore D.L.
        • et al.
        Traumatic posterior fossa haemorrhage in children.
        Acta Neurochir. 1982; 62: 79-85
        • Balasubramaniam V.
        • Ramesh V.G.
        A case of coup and contrecoup extradural hematoma.
        Surg Neurol. 1991; 36: 462-464
        • Mishra A.
        • Mohanty S.
        Contre-coup extradural hematoma: a short report.
        Neurol India. 2001; 49: 94-95
        • Mituyama T.
        • Ide M.
        • Kawamura H.
        Acute epidural hematoma caused by contrecoup head injury–case report.
        Neurol Med Chir (Tokyo). 2004; 44: 584-586
        • Miyazaki Y.
        • Isojima A.
        • Takekawa M.
        • et al.
        Frontal acute epidural hematoma due to contrecoup injury. A case report.
        No Shinkei Geka. 1995; 23: 917-920
        • Motohashi O.
        • Omura T.
        • Kameyama M.
        • et al.
        Acute epidural hematoma caused by contrecoup injury.
        No To Shinkei. 2000; 52: 833-836
        • Okamoto H.
        • Harada K.
        • Yoshimoto H.
        • et al.
        Acute epidural hematoma caused by contrecoup injury.
        Surg Neurol. 1983; 20: 461-463
        • Erbayraktar S.
        • Tekinsoy B.
        • Acar F.
        • et al.
        Posttraumatic isolated infarction in the territory of Heubner’s and lenticulostriate arteries: case report.
        Kobe J Med Sci. 2001; 47: 113-121
        • Dharker S.R.
        • Mittal R.S.
        • Bhargava N.
        Ischemic lesions in basal ganglia in children after mild head injury.
        Neurosurgery. 1993; 33: 863-865
        • Fujimura M.
        • Kameyama M.
        • Motohashi O.
        • et al.
        Cerebral infarction in the caudate nucleus associated with acute epidural hematoma and diffuse brain injury in a child after severe head injury.
        Childs Nerv Syst. 2004; 20: 430-433
        • Maki Y.
        • Akimoto H.
        • Enomoto T.
        Injuries of basal ganglia following head trauma in children.
        Childs Brain. 1980; 7: 113-123
        • Motohashi O.
        • Omura T.
        • Kameyama M.
        Cerebral infarction in eleven children without moyamoya disease.
        Nerv Syst Child. 1995; 20 (in Japanese): 116-141
        • Osborn A.G.
        Craniocerebral trauma.
        in: Osborn A.G. Diagnostic Neuroradiology. Mosby, St Louis1994: 199-247
        • Brown F.D.
        • Mullan S.
        • Duda E.E.
        Delayed traumatic intracerebral hematomas. Report of three cases.
        J Neurosurg. 1978; 48: 1019-1022
        • Kaufman H.H.
        • Moake J.L.
        • Olson J.K.
        • et al.
        Delayed and recurrent intracranial hematomas related to disseminated intravascular clotting and fibrinolysis in head injury.
        Neurosurgery. 1980; 7: 445-449
        • Tsubokawa T.
        • Yamada J.
        • Tomizawa N.
        • et al.
        Classification of traumatic intracerebral hematoma by repeated CT scan and clinical course.
        Neurol Med Chir (Tokyo). 1979; 19: 1127-1137
        • Evans J.P.
        • Scheinker I.M.
        Histologic studies of the brain following head trauma, ΙΙ. Posttraumatic petechial and massive intracerebral hemorrhage.
        J Neurosurg. 1946; 3: 101-113
        • Nakamura N.
        Dynamics of head injury.
        Neurosurgical Injury. 1969; 1: 7-23
        • Gade G.F.
        • Becker D.P.
        • Miller J.D.
        • et al.
        Pathology and pathophysiology of head injury.
        in: Youmans J.R. Neurological Surgery. W.B. Saunders, Philadelphia1990: 1965-2016