Traumatic posterior fossa subdural hematomas.

BACKGROUND: Traumatic hematomas in the posterior fossa are rare, especially traumatic posterior fossa subdural hematomas (SDHs), which account for <1% of head injured patients. The aim of this study was to investigate the features of traumatic posterior fossa SDHs.

METHODS: We retrospectively reviewed clinical and radiologic findings, management, and outcomes of patients with traumatic posterior fossa SDH.

RESULTS: Ten patients with traumatic posterior fossa SDHs were admitted to our hospital. There were seven males and three females, with an age range of 3 years to 97 years (mean, 57.5 years). Coagulopathies were observed in five patients. The causes of injury were motor vehicle crash in three patients, falls in six patients, and being hit by an iron plate in one patient. The mean admission Glasgow Coma Scale score was 8.3. Skull fractures were revealed in six patients. Hematoma sizes ranged from 5 mm to 20 mm (mean, 7.7 mm). Two patients presented with isolated posterior fossa SDHs, and eight patients presented with associated intracranial lesions. Only one patient was treated surgically for posterior fossa SDHs associated with intracerebellar hematomas. The poor outcome rate was 90% and the mortality was 50%.

CONCLUSIONS: A review of the literature revealed the following characteristics of posterior fossa SDHs: (1) a relatively high frequency of occipital impacts and fractures, (2) a low Glasgow Coma Scale score, (3) a high frequency of associated intracranial lesions, especially supratentorial lesions and intracerebellar hematomas, (4) a potential for lesion evolution, especially within 2 days, and (5) a high poor outcome rate and mortality.

LEVEL OF EVIDENCE: IV.