1. EPIDURAL HEMORRHAGE PRESENTING WITH HEADACHEı.
EPIDURAL HEMORRHAGE PRESENTING WITH HEADACHE
Burcu KÖKOĞLU¹,Çağrı KÖKOĞLU², İlhami ÜNLÜOĞLU¹
1 Eskişehir Osmangazi University Medical Faculty, Department of Family Medicine
2 Eskişehir Yunus Emre State Hospital, Department of Neurosurgery
CASE REPORT
A 51 years old male patient slipped his foot and hit his head while going downstairs. Patient applied to emergency service complaining headache without losing consciousness. He expressed that he came to emergency room by his own vehicle. There was nothing special about his personel and family medical history. He was alert, oriented and cooperative; his GCS was 15, blood pressure was 130/980 mmHG and pulse was 76 beats/min. Lungs were clear to auscultation and he had a regular rate and rhythm without murmur. Peripheral pulses are palpable and symmetrical bilaterally. Rebound tenderness, defence or organomegaly weren’t present. On neurological examination; he was clear consciousness , oriented , cooperative, no memory loose. Fundoscopic exam was normal. Pupillary isochoric , LR + / + , 4 exrtemity were active ,and no muscle strength loose , reflex of deep tendon were normoactive, no pathological reflexes , cerebellar tests were normal . The patient was taken to observation room, and complete blood tests; hemogram, hemostasis and general biochemical tests
Performed laboratuary tests results HGB: 14.1gr/dl , WBC: 7180 ,PLT: , PT: 10.2sn, aPTT: 20 sn, INR: 0.89 , GLU:149 mg/dl, AST:17 U/l, ALT:11 U/l, Amylese:94 U/l, T.BİL:0,5 mg/dl, D.BİL:0,1 mg/dl, NA:142 mmol/lt, K:4,18 mmol/lt, CL:104 mmol/lt. Because of the good general condition of the patient ,stable vitals and normal blood test results he was taken to emergency care unit. Ongoing headache patients 1 g metamizol sodium injection was performed. While he was waiting at Emergency care unit, the vital checks were performed half hourly. After 4 hour headache was filmed CT on the continuation of the complaint. Patient is prediagnosed as acute epidural hemorrhage through the brain CT. After neurosurgery consultation patient is sent to neurosurgical insentive care room.
Figure 1 : lateral cervical and head x-ray
Family physician residents rotate through the Emergency Room. Head traumas are becoming a significant issue in our time and its importance is increasing due to growing population and widening vehicles. Head trauma incidence is reported estimately / in developed countries. Nearly to 1,5 million people visit the emergency service per year due to head traumas. Considering these numbers, the question is: «Does every person exposed to head traumas require a CT?» There is controversial opinions about this. One group of physicians argue performing CT to every patient causes unnecessary radiation, while the other group stands up for the idea of avoiding malpractice by every possibility.
Acute epidural hemorrhage can present with loss of consciouss, convulsion, vomitting, nausea, syncope, motor deficit, it also might show a single symptom like headache as the case we presented. On this case, we aim to indicate the necessity of using imaging methods.
Figure 2:cranial CT
Keywords: epidural hemorrhage, headache