0:01

While the typical etiology for an epidural

0:04

hematoma is tearing of the middle meningeal artery

0:09

from a fracture associated with the squamosal

0:12

portion of the temporal bone, one might also see

0:16

epidural hematomas when there has been trauma

0:19

to the venous sinuses or arachnoid granulations.

0:24

Here is just such a case.

0:26

When we look at this axial scan,

0:29

what we find is the patient has had extensive trauma

0:32

with a comminuted fracture of the occipital bone,

0:36

which I'll show in a bone window in just a moment.

0:38

But more importantly, what we see is a collection of

0:43

blood, which crosses the midline in the posterior fossa.

0:49

And in addition, it crosses from the posterior fossa

0:53

into the supratentorial space.

0:56

So it has effectively dissected the dura of the

0:59

brain that is associated with the tentorium.

1:02

It's crossing the tentorium above and below in

1:06

the supratentorial and infratentorial space.

1:10

So this collection, by its nature,

1:13

must be in an epidural location.

1:16

This patient had a CT venogram, which you see here,

1:21

showing that there has been disruption of

1:24

the transverse sinus on the right side.

1:27

We got a little bit of contrast here, but we're

1:29

missing the vast majority of the transverse sinus, and

1:33

when you reconstruct the thin sections to a sagittal

1:37

plane, what you see on the right-hand side is this

1:40

collection is going behind the superior sagittal sinus

1:45

and the torcula, and it's this collection right here

1:50

that is dissecting the dura and

1:52

therefore is in an epidural location.

1:55

You notice also that the patient has

1:57

had a fracture here, so let's just pull

1:59

down the bone windows for just a moment.

2:02

We have the fracture and its involvement of the

2:06

occipital bone, multiple comminuted portions here, with

2:13

the collection underlying it in the epidural location.

2:19

So this is a venous source of an epidural

2:23

hematoma as opposed to the more typical

2:25

or more commonly seen arterial

2:28

meningeal artery source of an epidural hematoma

2:32

associated with a temporal bone fracture.

Case: Epidural Hematoma from Transverse Sinus Injury on CT

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