The most common symptoms of eosinophilic granuloma are local tenderness and an enlarged skull mass. The presence of epidural hematoma is a very rare symptom of eosinophilic granuloma. To our knowledge, this is only the second reported case of eosinophilic granuloma with epidural hematoma. A 2-year-old boy with a soft tumor on the occipital scalp, palpable at the age of 3 months, yet with no obvious history of trauma, was admitted due to a sudden onset of loss of consciousness. A brain computed tomography scan showed a lytic lesion on the occipital skull with a large epidural and subcutaneous hematoma, causing brain compression. He underwent an emergency craniectomy with removal of both the tumor and hematoma. The patient regained consciousness and had no residual neurological damage. Pathological reports showed abnormal proliferation of Langerhans’ cells, eosinophilic cells and multinucleated cells. A whole-body bone nuclide scan revealed no other bone lesions. The patient was discharged uneventfully. The causes of hematomas are not very clear. They may be due to tumor necrosis or minor trauma. In our presented case, the cause of the epidural hematoma may have been tumor bleeding which ruptured into the epidural space. A solitary eosinophilic granuloma of the skull with acute epidural hematoma and loss of consciousness is extremely uncommon. Craniectomy with removal of the tumor and hematoma decompression may produce good results.

Keywords:
Eosinophilic granuloma, Epidural hematoma, Histiocytosis X
1.
Lichtastein: Histiocytosis X. AMA Arch Pathol 1953;56:84–122.
2.
Puzzilli F, Mastronardi L, Farah JO, Ruggeri A, Lunardi P: Solitary eosinophilic granuloma of the calvaria. Tumori 1998;84:712–716.
3.
Slater JM, Swarm OJ: Eosinophilic granuloma of bone. Med Pediatr Oncol 1980;8:151–164.
4.
Arseni C, Danaila L, Constantinescu A: Cranial eosinophilic granuloma. Neurochirurgia (Stuttg) 1977;20:189–199.
5.
Lieu AS, Hwang SL, Howng SL, Chai CY: Brain tumors with hemorrhage. J Formos Med Assoc 1999;98:365–367.
6.
Nakagawa Y, Yoshino E, Suzuki K, Tatebe A, Andachi H: Spontaneous epidural hematoma from hepatocellular carcinoma metastasis to the skull: Case report. Neurol Med Chir (Tokyo) 1992;32:300–302.
7.
Simmons NE, Elias WJ, Henson SL, Laws ER: Small cell lung carcinoma causing epidural hematoma: Case report. Surg Neurol 1999;51:56–59.
8.
Abou-Samra M, Marlin AE, Story JL, Brown WE Jr: Cranial epidermoid tumor associated with subacute extradural hematoma. Case report. J Neurosurg 1980;53:574–575.
9.
Manaka S, Izwa M, Nawata H: Skull tumor simulating sinus pericranii. Case report. J Neurosurg 1977;46:671–673.
10.
Arunkumar MJ, Haran RP, Chandy MJ: Spontaneous fluctuation in the size of a midline posterior fossa arachnoid cyst. Br J Neurosurg 1999;13:326–328.
11.
Lane B: Erosions of the skull. Radiol Clin North Am 1974;12:257–282.
12.
Vandenberg HJ Jr, Coley BL: Primary tumor of the cranial bones. Surg Gynecol Obstet 1950;90:602–612.
13.
Jeisma F, Ross PJ: Tumor-like lesions of the calvaria (due to general disease processes). Am Surg 1963;29:247–255.
14.
Rawlings CE 3rd, Wilkins RH: Solitary eosinophilic granuloma of the skull. Neurosurgery 1984;15:155–161.
15.
Mitnick JS, Pinto RS: Computed tomography in the diagnosis of eosinophilic granuloma. J Comput Assist Tomogr 1980;4:791–795.
16.
Martinez-Lage JF, Poza M, Cartagena J, Vicente JP, Biec F, De Las Heras M: Solitary eosinophilic granuloma of the pediatric skull and spine. The role of surgery. Childs Nerv Syst 1991;7:448–451.
17.
Feldman RB, Moore DM, Hood CI, Hiles DA, Romano PE: Solitary eosinophilic granuloma of the lateral orbital wall. Am J Ophthalmol 1985;100:318–323.
18.
Groopman JE, Golde DW: The histiocytic disorders: A pathophysiologic analysis. Ann Intern Med 1981;94:95–107.
19.
Yang JT, Chang CN, Lui TN, Ho Ys: Eosinopilic granuloma of the skull: Report of 4 cases. Changgeng Yi Xue Za Zhi 1993;16:257–262.
20.
Brisman JL, Feldstein NA, Tarbell NJ, Cohen D, Cargan AL, Haddad J Jr, Bruce JN: Eosinophilic granuloma of the clivus: Case report, follow-up of two previously reported cases, and review of the literature on cranial base eosinophilic granuloma. Neuorsurgery 1997;41:273–279.
© 2001 S. Karger AG, Basel
2001
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