Bilateral Extradural Hematomas Research Articles

Acute synchronous bilateral extradural hematoma, a scarcely reported, rare entity

Objective: Extradural hematomas (EDHs) are contact injuries resulting from blunt trauma to the skull. It may be unilateral or bilateral. Bilateral acute extradural hematoma (EDH) was rarely reported before the advent of computed tomography. Mortality rates vary from 10.0%-40.0% and are an index of alertness and efficiency of health care and hospital set-up. EDH is an injury with preventable mortality in most cases. Bilateral acute extradural hematomas no longer confer high mortality of pre-CT era because of early diagnosis on CT, and prompt neurosurgical intervention. We present our experience with Bilateral EDH cases with an aim to investigate clinical, GCS score, and radiological features and also to analyse outcomes in these patients. Material and methods: We analyzed cases of EDH who presented at our centre from January 2023 to December 2023 and further investigated ten cases of bilateral EDH. All the patients were examined clinically and a plain computerized tomography scan of the head was performed. The clinical details of all patients, GCS at admission and discharge, radiological findings on CT and neurosurgical intervention performed, and GOS (Glasgow outcome score) were noted. Results: Road traffic accident was the reason for traumatic brain injury in all the cases. The GCS at admission was between 13–15 in 2 patients, 8–12 in 6 and 3–7 in 2 patients. Bilateral EDH was found in all of our patients .9 out of 10 cases were males. On CT head underlying fracture was seen in all cases. The localization of epidural hematomas in CT scans was bifrontal in four of the cases. All cases were treated with surgical management. The GOS Score was 5 in eight of the patients. Conclusion: Posttraumatic bilateral acute extradural hematoma is a rare entity, but now does not show the high mortality previously seen in the preCT era. This is due to early radiological diagnosis on CT and profuse monitoring combined with expeditious operative procedures.

Post Traumatic Biparietal Mirror Extradural Haematoma – A Case Report and Review of Literature

Abstract Bilateral extradural haematomas [EDH] are rare and it is an uncommon consequense of cranio cerebral trauma. The mortality is higher than unilateral extradural haematoma and management of extradural haematomas requires careful planning, judicial surgical exposure and most important is timing of evacuation of extradural haematomas. Emergency evacuation of bilateral extradural haematomas were performed in this case with uneventful postoperative period. The pathophysiology and surgical nuances of this rare entity been discussed.

A combination of acute and delayed contralateral epidural hematoma

Introduction. An acute bilateral extradural hematoma is an uncommon presentation of traumatic head injury; however, it leads to higher mortality rate than acute unilateral hematoma. A delayed epidural hematoma (DEDH) is a hematoma that is not present on initial computed tomography (CT) scan but is found on subsequent CT. While reviewing the literature, we could not find recently published papers considering supratentorial DEDH after primary operated contralateral EDH. Case report. A comatose 14-year-old male, with Glasgow Coma Scale score 4 and the right midriatic pupil on the side of the blunt trauma to the head, was admitted to ICU after he had survived a traffic accident. 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 intracranial pressure (ICP) monitor was implanted, which showed the increased values of ICP. A control brain CT scan performed within 24 hours showed a new contralateral occipitoparietal epidural hematoma. Another operation was performed. Second, control CT brain scan showed favorable finding. The patient was transferred after 25 days to the rehabilitation center, with the disability rating score of 11 and after 3 months it was1. Conclusion. A contralateral DEDH is a lifethreatening neurosurgical emergency case which can occur during the first 24 hours after decompressive craniectomy. Control and ICP monitoring is recommended in these cases, especially after surgical decompression.

Mirror image extradural hematoma in elderly population: management strategy with surgical bilateral or unilateral evacuation or conservative treatment modality with literature review

Abstract Extradural hematomas (EDH) represent one of common imaging findings in cases sustaining traumatic brain injury. Bilateral extradural haematoma is considered rare and even rarer in elder people male. Bilateral extradural hematoma is usually acute, and generally associated with severe traumatic head injury. Mirror-image extradural hematomas (MEDH) constitute a special type of bilateral extradural hamatomas, which is placed anatomically symmetrically on both the sides of the intracranial compartment, requires prompt diagnosis and emergent surgical intervention as it carry high mortality if evacuation of hematoma is not carried out expeditely. The mortality rate still remains higher in comparison to unilateral single extradural hematomas. The postoperative outcome depends on preoperative neurological status, total volume of blood, accurate diagnosis and prompt shifting to neurosurgical facility, expatiation of surgical procedure, pre- hospital care. Authors report a case of a - 65-year-old man who presented with acute simultaneous bilateral extradural haematomas following road traffic accident, underwent bilateral trephine craniotomy and simultaneous evacuation on both side led to good recovery.

Mirror-Image Epidural Hematoma

Mirror-image extradural hematomas (EDH) are bilaterally symmetrical and have same anatomical location on either sides. These are very rare and associated with high mortality unless managed emergently with surgical evacuation. Incidence of mirror-image EDHs is approximately 1.7%. Bilateral EDHs are of two types based on the source of bleeding. In the more common type, the bleeding source is venous and presents in a delayed manner, whereas the second type has arterial bleeding and presents more acutely and can deteriorate at an exceedingly fast pace. Quick decompression is the key in these cases to improve the outcomes. The authors illustrate a case of mirror-image EDH over parieto-occipital region that was evacuated surgically with bicoronal scalp incision and separate bilateral parietal craniotomies with excellent outcome.

Bilateral Extradural Hematoma: A Case Report

The occurrence of bilateral extradural hematomas is an uncommon consequence of cranio-cerebral trauma. In the literature bilateral, extradural hematomas have rarely been reported. This article is about a case of 45-year-old female who was admitted in our hospital with a history of road traffi c accident. On admission, she was conscious but irritable having Glasgow coma scale 14/15. In stable condition, she was found to have visual agnosia for left eye. Her computed tomography scan showed a bilateral symmetrical site with asymmetrical dimensions. Patient underwent left occipito-posterio-parietal craniotomy with complete removal of extradural hematoma was done. Right occipital extradural hematoma was not removed.

Bilateral post-traumatic acute extradural hematomas: A report of four cases and review of literature

Bilateral extradural hematomas are rare and follow significant trauma. The mortality is higher than with unilateral single extradural hematomas and postoperative outcome depends on preoperative neurological status.

A rare case of spontaneous bilateral extradural hematoma in a sickle cell disease child

A rare case of spontaneous bilateral extradural hematoma in a sickle cell disease child

Bilateral extradural haematoma after acute ventricular over-drainage

Background: Ventricular over-drainage is a common complication of dysfunctional ventriculoperitoneal devices. Subdural haematomas are usually the most common lesions associated with that complication. Such lesions may arise after ventricular collapse and bridging veins disruption that follows over-drainage, thus contributing to distortion of brain parenchyma, increased intracranial hypertension and neurological decline. More rarely, extradural haematomas may also be observed after ventricular shunt hyperfunction and may result in rapid neurological decline unless a surgical procedure can be promptly performed.Case: This study reports the case of a 38-old-woman who presented supratentorial hydrocephalus and developed bilateral extradural haematomas after the placement of a ventricular shunt device. Both haematomas were surgically approached and the dysfunctional shunt device was replaced.Conclusion: Extradural haematomas may develop precociously after ventricular over-drainage. Surgical treatment is mandatory and must include not only the evacuation of haematoma, but also the replacement of dysfunctional shunt to prevent further recurrence. The pathophysiology of extradural haematomas consequent of ventricular over-drainage and the possible use of a programmable valve to prevent these lesions are briefly discussed.

Bilateral extradural hematoma formation following excision of a thoracic intradural lesion

The authors report an unusual case of a 15-year-old girl who previously underwent resection of a posterior fossa medulloblastoma, and later underwent resection of a thoracic extramedullary metastatic lesion. Her consciousness deteriorated hours after removal of her spinal metastasis. A CT head scan identified bilateral extradural cranial hematomas, which were evacuated. To the authors' knowledge, this is the first report of a patient developing bilateral acute cranial extradural hematomas following excision of a thoracic intradural lesion.

Bilateral extradural haematomas.

Eleven cases of bilateral extradural haematomas were encountered in a total of 49 cases of extradural haematoma during a period of 4 years among 1000 consecutive cases of acute head injury. Assault was held responsible for 60 per cent of the total head injuries. Most of the patients were seen late; 8 were already unconscious and 5 had dilated fixed pupils. All 11 patients died, 4 soon after admission. Nine cases were found to have associated brain damage at autopsy. In 2 cases bilateral extradural haematomas with compression of the brain were the only intracranial abnormalities. In 4 cases a clost was missed on conventional exploration.

Hematomas epidurales bilaterales simultáneos

Epidural haematomas are one of the most common complications of closed head injuries. Bilateral extradural haematomas are rare, usually acute, and generally associated with severe trauma and a high mortality. The purpose of this paper is to present six cases of bilateral extradural haematomas seen at our service during the last 24 years and found an incidence of 2.5% of all cases of extradural haematomas surgically treated. There were 5 males and 1 female with a mean age of 32.6 years (range 16-55). In 3 cases haematoma was across the midline and in the other 3 cases haematomas was found at different locations on either side. Skull fracture was present in all cases. Surgical approach was the primary treatment in all cases. Mortality in our series was 50%. Bilateral extradural haematomas is a rare condition and the prognosis is mainly dependent of the pre-operative neurological state.

Bilateral asynchronous acute epidural hematoma : a case report.

BackgroundBilateral extradural hematomas have only rarely been reported in the literature. Even rarer are cases where the hematomas develop sequentially, one after removal of the other. Among 187 cases of operated epidural hematomas during past 4 years in our hospital, we found one case of sequentially developed bilateral epidural hematoma.Case PresentationAn 18-year-old conscious male worker was admitted to our hospital after a fall. After deterioration of his consciousness, an emergency brain CT scan showed a right temporoparietal epidural hematoma. The hematoma was evacuated, but the patient did not improve afterwards. Another CT scan showed contralateral epidural hematoma and the patient was reoperated. Postoperatively, the patient recovered completely.ConclusionsThis case underlines the need for monitoring after an operation for an epidural hematoma and the need for repeat brain CT scans if the patient does not recover quickly after removal of the hematoma, especially if the first CT scan has been done less than 6 hours after the trauma. Intraoperative brain swelling can be considered as a clue for the development of contralateral hematoma.

Bilateral frontal extradural haematomas caused by rupture of the superior sagittal sinus: case report

A 26-year-old male sustained simultaneous massive bilateral frontal extradural haematomas following a head injury as a result of a large tear of the superior sagittal sinus, without fracturing of the skull vault.

Acute bilateral extradural haematoma of the posterior cranial fossa

Traumatic haematomas located in the posterior fossa are less frequent than those above the tentorium. Extradural haematomas are the most common type of haematomas in the posterior fossa and are usually unilateral. We present the case of a patient with a bilateral extradural haematomas of the posterior fossa and review eight cases previously reported in the literature.

Rapid decompression of chronic hydrocephalus resulting in bilateral extradural hematomas; a general surgical complication

This article reports the potential complications that follow surgical disruption of the distal peritoneal catheter when it serves to regulate cerebrospinal fluid flow through the shunt system.

Bilateral traumatic extradural haematomas: report of 12 cases with a review of the literature

We are reporting 12 cases of traumatic bilateral extradural haematomas. The incidence was 4.8% of all cases of extradural haematomas. The most common site was the frontal region. CT scan examination was necessary for early diagnosis. Ten patients were operated upon while one patient was treated conservatively. Two patients died. The relevant literature is reviewed.

A case of coup and contrecoup extradural hematoma

We report an unusual type of a bilateral extradural hematoma: one due to direct injury and another due to the contrecoup effect. The second evolved after the first hematoma was evacuated.

Bilateral Extradural Hematomas in a Thrombocytopenic Infant Receiving Anticoagulants: Case Report

Abstract A unique case of bilateral extradural hematomas in an infant is reported. Relevant aspects of the patient's history, including the absence of any known trauma and the presence of an underlying coagulopathy are discussed. The radiographic and operative findings of this case are presented, and an explanation of the mechanism of the hematomas is offered.

Acute simultaneous bilateral extradural hematoma

A patient with acute simultaneous bilateral extradural hematomas is presented and the mechanism of formation and the sequence of operations necessary to reduce the risk of disability are discussed. The recent literature is reviewed and it is suggested that two types of bilateral extradural hematoma may be found, depending upon whether venous or arterial bleeding is responsible.