THE ANGIOGRAPHIC DIAGNOSIS OF EXTRADURAL HEMATOMA OF THE POSTERIOR FOSSA

Although extradural hematomas that involve the posterior fossa are relatively rare, they are amenable to surgical treatment. The clinical presentation is usually typical, but frequently a long delay precedes the diagnosis. Associated injuries frequently confuse the clinical appraisal. In a review of the literature, Reigh and O’Connell¹⁵ reported concomitant supratentorial lesions in more than 20 per cent of patients with extradural hematoma of the posterior fossa. Carotid arteriography is often performed on patients with acute injuries of the head. The discovery of a supratentorial subdural, extradural, or intracerebral hematoma may discourage further investigation, even when cerebellar signs are present.

Extradural hematomas that involved the posterior fossa and were demonstrated by arteriography are described in 4 patients. The angiographic approach to diagnosis is discussed.

We urge that vertebral arteriograms be added to the study of patients with occipital head trauma, particularly if evidence of a fracture is present on the plain roentgenogram. The vertebral study should be done in the submentovertex projection as well as in the standard Towne and lateral projections. The submentovertex projection permits a tangential view of the region in which most or all extradural hematomas of the posterior fossa occur. Because cerebral circulation is slowed, delayed roentgenograms should be obtained to ensure demonstration of the dural venous sinuses.

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