A low-order domestic pressure cooker explosion resulted in a 6.5 × 2.7-cm occipitoparietal extradural hematoma with a 5.8-mm midline shift in a 56-year-old woman, requiring emergency craniotomy, according to a recent case report.
The patient presented 2 to 3 hours following blunt head trauma sustained when she was struck by a pressure cooker lid during a domestic explosion. She reported persistent headache and one episode of vomiting without loss of consciousness or seizure activity. Upon arrival, she was hemodynamically stable with a Glasgow Coma Scale score of 14 (E3V5M6). Her pupils were 3 mm in diameter and responded promptly to light. Primary and secondary trauma surveys identified a 1 × 1-cm left temporal laceration without additional injuries.
Given the mechanism of high-velocity blunt trauma and symptoms with a Glasgow Coma Scale score of less than 15, the patient underwent noncontrast computed tomography of the head. Imaging demonstrated a minimally displaced left parietal skull fracture extending into the temporal bone and a 6.5 × 2.7-cm occipitoparietal extradural hematoma. Associated findings included intralesional air foci, adjacent contusions, compression of the ipsilateral lateral ventricle, and a midline shift of 5.8 mm.
Extradural hematoma is most associated with high-impact trauma and arterial bleeding, frequently involving the middle meningeal artery. Surgical management is advised when patients exhibit neurologic decline, hematoma thickness above 15 mm, a midline shift greater than 5 mm, or a Glasgow Coma Scale score below 9. In this case, symptomatic mass effect and a midline shift of greater than 5 mm prompted urgent operative management.
The patient underwent emergency craniotomy with evacuation of the extradural clots and bleeding control near the fracture line. Postoperative imaging showed complete resolution of the hematoma with a cranioplasty defect and subcutaneous emphysema. Her recovery following surgery was without complications. She was discharged on postoperative day 5 neurologically intact and remained asymptomatic at follow-up.
The investigators classified pressure cooker explosions as low-order blasts that generate subsonic pressure waves and primarily cause injury through secondary projectiles rather than primary overpressure effects. Although these events more commonly result in burns, soft-tissue injury, or maxillofacial trauma, intracranial hemorrhage is described as rare as a result of the localized nature of the explosive mechanism.
The investigators cited a large retrospective analysis in which approximately one-quarter of surgically treated extradural hematomas were attributed to domestic injuries. They also summarized prior case reports of pressure cooker–related head trauma, including penetrating transorbital injury, traumatic brain injury in a pediatric patient, and blunt head injury with skull fracture, with generally favorable neurologic outcomes following surgical or conservative management.
“This case illustrates that low-order domestic blast injuries can still produce life-threatening intracranial damage due to secondary projectiles, highlighting the critical role of early CT imaging and timely neurosurgical intervention,” noted lead report author Sri Hari Babu Sunkari, MBBS, of the Department of Trauma and Emergency at the All India Institute of Medical Sciences in Nagpur, India, and colleagues.
The authors reported no conflicts of interest.
Source: Cureus
