Abstract
Head injury is one of the leading causes of death and disability in traumatic accidents. Post-operative contralateral epidural hematomas after surgery for acute subdural hematoma seem to be rare. In this case, expansion and spontaneous resolution of a fractural epidural hematoma contralateral to the side of acute subdural hematoma is presented. The importance of immediate post-operative computed tomography is also highlighted to detect delayed traumatic mass lesions.
Highlights
Despite recent advances in diagnostic and therapeutic modalities, acute Subdural hematoma (SDH) remain among the most lethal traumatic lesion of the brain, with a mortality rate of approximately 50-74% [1]
Another important factor influencing the outcome of such patients is the presence and/or evolution of contralateral hematomas
Case presentation We report a 19-year-old Caucasian male of Iranian Nationality with acute right-sided traumatic SDH with presenting Glasgow Coma Scale score of 6/15 and Computed tomography (CT) evidence of severe brain swelling and associated midline shift and contralateral small fractural Epidural hematoma (EDH) in the temporoparietal region (Figure 1)
Summary
Despite recent advances in diagnostic and therapeutic modalities, acute SDHs remain among the most lethal traumatic lesion of the brain, with a mortality rate of approximately 50-74% [1]. Outcome has been found to be related to clinical features such as patient’s age, traumatreatment span, pupil status, presence of lucid interval, associated extracranial injuries, and intracranial hypertension [2,3] Another important factor influencing the outcome of such patients is the presence and/or evolution of contralateral hematomas. Cases Journal 2009, 2:6282 http://casesjournal.com/casesjournal/article/view/6282 grand mal seizures, and intractably elevated ICP have been proposed as some hints to the detection of this pathology [5,7] These signs and symptoms may have more common causes than evolution of contralateral EDH such as: reaccumulation of hematoma and brain edema [6]. On presentation of these clues, immediate CT is recommended, since it may lead to emergent evacuation surgery [1]. The patient was discharged 3 months after admission in persistent vegetative state
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