Isolated Retrodental Epidural Hematoma Without Dens Fracture

Liqaa Raffee; Bashar Abuzayed; Majdi Al Qawasmeh; Khaled Alawneh; Khalid Abdalla; Abdelwahab Aleshawi

doi:10.1016/j.jemermed.2019.09.008

Isolated Retrodental Epidural Hematoma Without Dens Fracture

J Emerg Med. 2020 Jan;58(1):67-71. doi: 10.1016/j.jemermed.2019.09.008. Epub 2019 Nov 15.

Authors

Liqaa Raffee¹, Bashar Abuzayed², Majdi Al Qawasmeh³, Khaled Alawneh⁴, Khalid Abdalla⁴, Abdelwahab Aleshawi⁵

Affiliations

¹ Department of Accident and Emergency Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
² The Specialty Hospital, Amman, Jordan.
³ Division of Neurology, Department of Neuroscience, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
⁴ Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
⁵ Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.

PMID: 31740157
DOI: 10.1016/j.jemermed.2019.09.008

Abstract

Background: Traumatic spinal epidural hematomas (TSEDH) are rare, with the reported incidence being < 1% of all spinal injuries. Causes of TSEDHs include vertebral fractures, obstetrical birth trauma, lumbar punctures, postsurgical bleeding, epidural anesthesia, and missile injuries. The retrodental location has not been reported as a location for spontaneous epidural hematoma.

Case report: A 4-year-old boy was admitted to our Emergency Department after falling down and experiencing head trauma. Glasgow Coma Scale score was 15/15 with no neurologic deficit. Brain computed tomography scan showed isolated hyperdense hematoma in the retrodental area without any fractures in the skull or cervical vertebrae. Brain and cervical magnetic resonance imaging showed a retrodental acute hematoma that was isointense in T1-weighted sequences and hypointense in T2-weighted sequences. The hematoma was in the epidural space with possible odontoid process intracapsular origin. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Isolated retrodental epidural hematoma without dens fracture is an extremely rare pathology and finding, and to the best of our knowledge, this is the first case to be reported in the literature. Emergency physicians should consider this pathology for any patients presenting for head trauma with head hematoma.

Keywords: dens; epidural hematoma; odontoid process; retrodental; trauma.