Delayed Massive Traumatic Hematoma in the Corpus Callosum: Two Case Reports with Literature Review

Abstract

had led him to be observed in our hospital because of head-ache. He was discharged with continuous headaches but without deterioration. The headache was deep-seated and relieved by the usual analgesics. The Glasgow Coma Scale (GCS) score was reported to be 15 on the initial neurological exam right after the trauma, and CT scan revealed no hema-tomas except some hemorrhage of the interhemispheric fis-sure cistern (Fig. 1A). On his second admission, the patient was lethargic, had a stiff neck and slight paralysis of the right lower limb, and urinary incontinence, and the cranial CT disclosed a massive hyperdense mass in the CC from the genu to the splenium (Fig. 1B). Assuming that a ruptured traumatic aneurysm or an arteriovenous malformation caused the hematoma, an emergency computed tomography angiography (CTA) was performed, but it yielded no pathological results. Repeat CTA, digital subtraction angiography (DSA), and magnetic resonance imaging (MRI) were performed on days 4, 7, and 8 after the second admission, respectively, to explore the potential etiology of the hematoma. However, no pathology was noted (Fig. 2A–D). Blood count, blood chemistry, bleeding, and coagulation times were found to be normal. The patient had no systemic disease such as high blood pres-sure, diabetes, or liver disease, or was not using of aspirin or anticoagulant medications. Because no neurological deterioration was observed after admission, conservative medical management was under-taken, including antiedematous treatment, antiepileptic therapy, anti-vasospasm therapy, and haemostatic therapy. The patient's condition improved gradually. Three weeks later, the patient was discharged with no obvious neurological deficit except slight left-handed apraxia. Three months later, a follow-up DSA image showed no demonstrable vascular abnormality (Fig. 2B). II. Case 2 A 39-year-old man who had no demonstrable predis-posing abnormalities was admitted approximately 2 hours after being involved in an accidental fall. He fell down from a height of about 3 metres, and he recovered after a transient period of unconsciousness. An emergency CT scan demonstrated subarachnoid hemorrhage (hemorrhage of the interhemispheric and right sylvian fissures) and right temporal and occipital bone fractures but no evidence of an intracranial hematoma (Fig. 1C). Coagulation function was normal. Approximately 12 hours after the injury, the patient looked A delayed massive traumatic hematoma in the corpus callosum is extremely rare. We report two cases with a delayed massive callosal hematoma caused by blunt head trauma. A massive callosal hematoma was diag-nosed by computed tomography (CT) 2 weeks after a minor head injury in a 29-year-old man. A similar but larger hematoma developed 12 hours post-trauma with acute onset of consciousness disturbance in a 39-year-old man. Emergency CT angiography revealed no vascu-lar pathologies in either case. The first patient was managed conservatively and recovered, whereas the second patient was treated surgically and died. The lit-erature was reviewed regarding the possible mechanism of production of these lesions following head injury and therapeutic considerations are discussed.