Repeated Spontaneous Intracranial Epidural Hemorrhage after Hysterical Crying: A Case Report.

Repeated Spontaneous Intracranial Epidural Hemorrhage after Hysterical Crying: A Case Report.

World Neurosurg. 2018 Mar 09;:

Authors: Chen CT, Lai HY, Chang TW, Lee CY

Abstract
BACKGROUND: Spontaneous epidural hemorrhage (EDH) is a rare occurrence that may be caused by vascular anomalies, infections, coagulopathies, or tumors. Spontaneous EDH occurring in patients without specific underlying disease has been reported only as intraspinal lesion but has never been demonstrated in the intracranial area. This study presents a 19-year-old patient with repeated spontaneous intracranial EDH caused twice by hysterical crying.
CASE DESCRIPTION: The patient had spontaneous left frontal EDH after hysterical crying. Two years later, she had a similar episode after crying, and a new spontaneous right frontal EDH was revealed. There was no obvious risk factor revealed by laboratory and radiological survey. We postulated that hyperventilation during crying resulted in a sudden decrease in intracranial pressure (ICP). The intracranial hypotension induced detachment of the dura from the skull and spontaneous EDH occurred.
CONCLUSIONS: Crying or hyperventilation may trigger spontaneous EDH and should be suspected when there are signs of persisting headache and increased ICP. The prognosis is excellent if early diagnosis and surgical decompression are achieved.

PMID: 29530694 [PubMed - as supplied by publisher]

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