Spontaneous epidural hematoma: A rare complication of sickle cell anemia

An emergent magnetic resonance imaging (MRI) of brain with MR-venography revealed multiple large extradural hematomas (7.5 Χ 4.6 Χ 7.8 cm) in left frontal region causing severe mass effect, subfalcine and uncal herniation and also a small (3.4 Χ 1.6 Χ 3.7 cm) right frontal extradural hematoma [Figure 1]. [4] Possible mechanisms for such hematomas are: [4],[5] (1) periosteal elevation secondary to bone infarction with disruption of the cortical bone margin, and bleeding into the epidural space; (2) involvement of epidural vessels in the vicinity of infracted bone can lead to spontaneous rupture of these vessels and formation of hematomas; (3) poor venous drainage leading to venous congestion and rupture of these thin-walled veins and (4) expanding hematopoietic tissue disrupting the inner and outer skull tables with bleeding into subgaleal and epidural spaces.