Presentation
Victim of assault, with multiple facial bone fractures.
Patient Data
Right anterior temporal extradural hematoma measuring 12 mm in depth. This exerts minimal mass effect on the temporal pole. No new intracranial hemorrhage. No hydrocephalus.
Right maxillary, orbital, and frontal bone fractures are present (not shown). Right-sided proptosis.
Comparison is made with CT brain performed yesterday. No significant change in size or morphology of the right anterior temporal extradural hematoma. Minimal mass effect on the adjacent temporal lobe. No new intracranial hemorrhage or evidence of acute ischemia. Ventricles within normal limits. Right orbital / facial bone fractures are unchanged.
Case Discussion
This case illustrates a benign form of extradural hemorrhage that may happen in the context of trauma and usually not requiring surgical intervention. The anterior temporal extradural hematomas are considered to have a venous source of bleeding (spheno-parietal sinus or its major draining veins) instead of the expected arterial origin of the extradural hemorrhages. For this reason, and also being located anteriorly in the middle cranial fossa, they are associated with a low risk of midline shift, uncal herniation, and brainstem compression.