Spontaneous epidural
hemorrhage has been described in a variety of clinical scenarios, including
chronic renal failure (CRF). During
hemodialysis, patients with CRF rarely develop spinal or
cranial epidural hematomas. Such
hemorrhages have been attributed to intracranial pressure fluctuations during
hemodialysis,
heparin administration, uremic-platelet syndrome, or
hypertension. Although the exact pathophysiology is not understood, this rare consequence of
hemodialysis has been well documented in the literature.
Hemorrhage in the absence of
hemodialysis therapy in a CRF patient, however, has not been previously reported. We report a 16-year-old boy with no history of
trauma who woke in the morning with severe
headache and resultant neurological deterioration. He was found to have a large left temperoparietal epidural
hematoma and underwent urgent surgical evacuation. Postoperatively he developed a contralateral extra-axial
hematoma that did not require surgical intervention. He recovered completely, with no significant neurological deficit. This unique presentation of spontaneous intracranial epidural
hemorrhage in an adolescent not receiving
hemodialysis highlights a rare, but serious, complication of CRF.