Acute Epidural Hematoma associated with a Subgaleal Hematoma treated by Percutaneous Needle Aspiration after Embolization of the Middle Meningeal Artery : A Case Report

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We report a case of acute epidural hematoma associated with a progressive subgaleal hematoma. A 16-year-old adolescent boy was admitted to another hospital after a motorcycle accident. Initial radiography and CT scan showed diastasis of the right lambdoid suture and subgaleal hematoma. CT scan and MRI on the next day revealed enlargement of the subgaleal hematoma communicating with the small epidural hematoma through the diastasis of the lambdoid suture. Cerebral angiography demonstrated continuous extravasation from the middle meningeal artery near the diastasis of the lambdoid suture. The acute epidural hematoma was speculated to have been formed by continuous bleeding from the injured middle meningeal artery into subgaleal space through the diastasis of the lambdoid suture which thereby caused enlargement of the subgaleal hematoma. After embolization of the middle meningeal artery by the endovascular technique, we punctured and completely aspirated the subgaleal hematoma. Percutaneous aspiration of the subgaleal hematoma after embolization of the middle meningeal artery was effective in this case of acute epidural hematoma associated with a subgaleal hematoma.