A combination of acute and delayed contralateral epidural hematoma

Abstract

Introduction An acute bilateral extradural hematoma is an uncommon presentation of a traumatic head injury; however, it leads to higher mortality rate than an acute unilateral hematoma. A delayed epidural hematoma (DEDH) is a hematoma not present on the initial computed tomography (CT) scan but is found on a subsequent CT scan. While reviewing the literature, we could not find recently published papers considering supratentorial DEDH after primary operated contralateral epidural hematoma.

Case outline A comatose 14-year-old male patient with Glasgow Coma Scale score of 4 and the right mydriatic pupil on the side of the blunt trauma to the head was admitted to the intensive care unit after he had survived a traffic accident. The initial brain CT scan showed an acute temporoparietal epidural hematoma on the right side of the cranium, with impressive midline shift and bilateral linear skull fracture. Surgery was performed and an intracranial pressure (ICP) monitor was implanted, which showed increased values of ICP. A control brain CT scan performed within 24 hours showed a new contralateral occipitoparietal epidural hematoma. Another operation was performed. A second, control CT brain scan showed favorable findings. The patient was transferred after 25 days to the rehabilitation center, with the disability rating score of 11, which was reduced to 1 after three months.

Conclusion A contralateral DEDH is a life-threatening neurosurgical emergency case which can occur during the first 24 hours after decompressive craniectomy. Control CT scans should be performed one day after the operation in order to verify and treat DEDH timely. A high degree of vigilance and ICP monitoring is recommended in these cases, especially after surgical decompression.

Keywords: brain trauma; delayed bleeding; extradural hematoma; intracranial pressure monitoring