Extra-Dural Hematoma

  • E. Zander
  • R. Campiche
Part of the Advances and Technical Standards in Neurosurgery book series (NEUROSURGERY, volume 2)


The extra-dural hematoma (or epi-dural if the Greek terminology is used) is in its classic form a wellknown clinical entity taught in all medical schools. This state of affairs is excellent but has unfortunately also a negative aspect to it, the diagnosis being still too often missed when the clinical findings do not correspond with the classical characteristic findings usually expected. The publication of more and more cases with an atypical evolution and cases of hematomas in unusual sites show that the diagnosis is not always easy and that the classical clinical findings are far from being the rule. Weinman48 for example only found the classical signs in 50% of his series of 86 cases, and Jamieson24 only 4 such cases in his study of 167 cases. The evolution of the hematomas in children and in old people often differs from that of the adult. If one considers the fact that the basic predominating phenomena in the formation and in the extension of the extra-dural hematomas are the source of conflicting opinions, it is easy to understand that the problem of extra-dural hematoma is still of great interest. To be convinced of this we just have to point out the discrepency which still exists, in spite of technical and diagnostic progress, between the number of extra-dural hematomas found clinically and operated on, and the number discovered at autopsy. Thus, in 1964, Heyser19 compared the frequency of extra-dural hematomas clinically found (2 to 3% of all head injuries hospitalised) to that found in the autopsy room (5.4 to 13.6%). This difference is even more remarkable in the cases of extra-dural hematomas in unusual sites; in 1963, Vigouroux46 also showed the difference between the clinical frequency of frontal hematomas (1 to 5%) and those discovered at autopsy (between 17 and 21%). Moreover, in studying the literature, one finds that very few series of cases have a mortality rate approaching the 20% of McKissock32, a figure higher than the basic unavoidable mortality rate of 10% estimated by Hooper in 1959 (quoted by Jamieson24). Certainly fundamental ideas are slowly being modified. For example, carotid angiography, which only a short while ago was contra-indicated because of the loss of time involved, is now more often performed and greatly contributes to a reduction in mortality to nearly 10%, the basic unavoidable mortality rate.


Head Injury Dura Mater Epidural Hematoma Burr Hole Cerebral Lesion 


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Copyright information

© Springer-Verlag/Wien 1974

Authors and Affiliations

  • E. Zander
    • 1
  • R. Campiche
    • 1
  1. 1.Neurosurgical DepartmentUniversity Cantonal HospitalLausanneSwitzerland

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