Traumatic Extradural Hematoma Research Articles

Post-Operative Outcome of Traumatic Extradural Haematoma in HOSHAS

Introduction: Traumatic extradural haematoma (EDH) is a common surgical emergency with huge socio-economic impact. Prompt diagnosis and management are key for patient survival and good outcome. Considering that neurosurgical units are mostly only available in tertiary centres, it is a challenge for non-neurosurgical centres to transport patient to the nearest neurosurgical unit for emergency surgery, which may be of significant distance away, hence, a delay in surgery. General surgery units are more widely available and general surgeons are trained to competently manage patients with EDH. Referring to the nearest general surgery unit for emergency surgery for EDH can be life-saving and avoid delay in surgery. There is a lack of study regarding outcome of patients with EDH operated by general surgeons, hence the aim of this study to investigate in this regard. To determine the post-operative functional outcome of patients with extradural haematoma in a nonneurosurgical centre, and compare the outcome with other centres. Materials and Methods: This study was a retrospective review of records of all post-operative patients operated in HOSHAS for traumatic EDH in year 2017. Sample were obtained from 2017 General Surgery Department operative census in HOSHAS. Data were obtained from patient admission records using a proforma. Documented patient post-operative functional status was classified as per Glasgow Outcome Scale (GOS). Data were analysed using SPSS version 22. Results: A total of 11 patient data were collected. Mean age of the study population is 27. All samples were male patients. Road traffic accident was the main mode of injury (82%). Seven patients had GCS on arrival of 9 to 12 (64%), while 4 patients had severe brain injury on arrival (36%). All except 1 patient with moderate brain injury (GCS on arrival 9-12) recovered well post-operatively. As for patients with severe brain injury on arrival (GCS 3-8), only half of the patients had complete recovery post operatively. Most of the patients (73%) had good post-operative recovery (GOS 4-5). One patient died (GOS 1) and another ended up in vegetative state (GOS 2). The post-operative outcome in this study is comparable to other studies done in neurosurgical unit. Conclusion: The functional outcomes of traumatic EDH patients operated by general surgeons in HOSHAS are similar to those in neurosurgical centre.

Surgical management of traumatic extradural hematomas in children: an analysis of 201 patients at a tertiary neurosurgical center.

The effects of traumatic extradural hematoma (EDH) are potentially reversible if treated early. Pediatric EDH differs from its adult counterpart because of the differential elastic and adherence properties of skull bone and dura respectively. There is a paucity of literature regarding prognosis and factors predicting the outcome of pediatric EDH. In this study, we aimed to study the factors predicting outcome and prognosis of traumatic EDH in the pediatric age group. We did a retrospective chart review of all pediatricEDH operated in our center between 2011 and 2017. Factors affecting prognosis were analyzed through univariate and multivariate analyses. Two hundred one patients qualified for the study. There were 159 boys and 42 girls with a sex ratio of 3.78:1. The most common modes of injury were road traffic accidents (n = 108, 53.3%) followed by falls from a height. The most common clinical presentation was vomiting (n = 168, 83.3%), followed by headache (n = 72, 35.8%). Pupillary asymmetry was present in 11.4% (n = 23) patients. The mean GCS at presentation was 12.71. The mean volume of EDH was 37.18cc, with a mean maximum thickness of 23.19mm. The most common location of the EDH was at temporoparietal region (n = 67, 33.3%). The median time of diagnosis from injury was 14.69h (SD, 32.9h). The mean GCS at discharge was 14.43 (SD ± 0.51). Sixteen patients were lost to follow; 185 patients were available for follow-up and were included in the outcome analysis. The mean GOS at follow-up was 4.9 (SD ± 0.368) with a median follow-up of 13.46months. In our cohort, only one child died. Univariate and multivariate analyses revealed that pupillary asymmetry, pyramidal signs, low GCS at presentation, associated parenchymal injuries, and post-operative complications correlated negatively with outcome, whereas vomiting correlated positively with outcome. Pediatric EDH differs from adults in complications as well as outcome. EDH in this pediatric cohort had a better outcome with very less mortality. Increased transportation facilities and the industrial revolution may have facilitated the shift of mode of injury from fall of height in the past to road traffic accidents in this study. A large study comparing the outcomes with pediatric and adult patients is warranted.

Toward zero mortality in acute epidural hematoma: A review in 268 cases problems and challenges in the developing country

Epidural hematoma (EDH) is one of the most life threatening lesion in patients with craniocerebral trauma. Traumatic extradural haematoma (EDH) is a neurosurgical emergency and timely surgical intervention for significant EDH is the gold standard. This study aims to determine the incidence and mortality of consecutive patients with traumatic EDH admitted to the Emergency Department (ED) of Dr. Soetomo General Hospital, Airlangga University in Surabaya. Retrospective analysis of prospectively collected data for all consecutive trauma cases admitted through the ED during January 2009–May 2012. EDH was diagnosed by CT in all cases. Both primary and delayed onset EDH were included, as were patients with combined EDH and other intracranial lesions (e.g. subdural haematoma). Age, sex, cause of injury, associated intracranial lesions, skull fracture, Glasgow Coma Scale, pupil reactivity, and clinical outcome were determined. We performed a chart review of 268 patients had complete data admitted to the emergency department with EDH diagnosed by CT scan and surgically treated between January 2009 and May 2012, mean of 15.41 patients per month. Seventy (77%) patients were male, with a mean age of 27.1 years. Sixty (73.86%) patients were from road traffic crashes, 40 (14.92%) sustained falls, 7 (2.61%) had direct head trauma. On admission, 81 (30%) patients were GCS 14–15, 116 (43%) GCS 9–13 and 71 (27%) GCS 3–8. Overall, 79 patients (29%) had anisocor pupils. Thirty-one patients (11.56%) died after neurosurgical operation. Outcome of EDH depends on the several factors, including trauma operation interval, patient's age, clinical status preoperative and associated other extracranial injury.

Surgical management of traumatic supra and infratentorial extradural hematomas: our experience and systematic literature review.

Post-traumatic supra and infratentorial acute extradural hematomas (SIEDHs) are an uncommon type of extradural hematoma with only few small series published. In this scenario, the purposes of the present study are to present our experience in the management of 8 patients with acute SIEDH and to perform a systematic literature review. The clinical and radiological data of 8 patients operated for SIEDH at our department were analyzed retrospectively. Using the PRISMA guidelines, we reviewed the articles published from January 1990 to January 2018 reporting data about SIEDH. A total of 3 articles fulfilled the inclusion criteria and were analyzed. The incidence of SIEDHs is very rare constituting < 2% of all traumatic extradural hematomas (EDH). SIEDHs are associated with non-specific symptoms. Only 20% of patients were in coma (GCS < 8) at admission. A "lucid interval" was not reported. The source of bleeding of SIEDH was venous in all cases due to the following: bone fracture with diploe bleeding (50%), transverse/sigmoid sinus injury (22%), oozing meningeal venous vessel (8%), detachment of transverse sinus without wall injury (6%), and unknown in the other cases. Due to the venous nature of the source of hemorrhage, the clinical manifestation of a SIEDH may develop in a slow way, but once a critical volume of hematoma is reached, the deterioration can become rapid and fatal for acute brain stem compression. Surgery is the mainstay of SIEDHs treatment: among 42 cases with SIEDH included in this review, 40 (95.23%) patients were treated with surgery while only two were managed conservatively. Also in our series, all patients underwent surgery. A combined supratentorial craniotomy and suboccipital craniotomy leaving in a bone bridge over the transverse sinus for dural tenting sutures resulted the most used and safe surgical approach. SIEDH is a rare type of EDH. Early diagnosis of SIEDH and prompt surgical evacuation with a combined supratentorial and suboccipital approach provide excellent recovery.

Delayed presenting traumatic Extradural Haematoma- whether surgery always necessary? – An experience in a tertiary care hospital.

Background: Extradural haematoma (EDH), considered being the most serious preventable complication of head injury, requiring immediate diagnosis and surgical intervention. Though surgical evacuation constitutes the definitive treatment of this condition but many patients who presented late to emergency can be saved from craniotomy with watchful repeated neurological assessments.Aims and Objectives: To evaluate the role of surgical and non surgical management of delayed presenting traumatic EDH at a tertiary care Hospital.Materials and Methods: This study was conducted from December 2015 to February 2017 at Nil Ratan Sircar medical College, Kolkata. A total 100 cases of traumatic Extradural Haematoma were admitted with history of prior head injury of greater than 8 hours duration. All the patients were assessed clinically on admission and by NECT brain either prior to or immediately after admission. All patients with traumatic EDH were evaluated by dedicated trauma team and by Neurosurgeons, patients who came to hospital facility with more than 8 hours history of incident with haematoma &lt;30 cm3, no associated midline shift and no signs of focal neurodeficits or papillary asymmetry with GCS 13-15, were initially managed conservatively, those who failed any of the chosen criteria treated by operative interventions.Results: Of all patients more 50% cases were associated with vehicular accident. Eighty percent cases were referred from primary or secondary care level hospitals and the remaining directly from accident site or scene of injury. Fifteen patients had post injury seizures, most of the cases were associated with additional intradural lesions like contusions or intracerebral haematoma. Approximately one forth patients presented with GCS &gt;13, all these patients experiences positive outcomes. In this series of EDH location was temporoparietal region constitute 45% of the total, in 36 % of cases there were associated skull fracture. 55% of the patients in this series underwent operative intervention and 45% treated non operatively. Overall, 78% patients had good recovery, whereas 12% patients remained moderate to severe disabled at 6 weeks follow up period.Conclusion: Although surgical management is the treatment of choice in EDH, in selected delayed presenting EDH patients can be managed non-operatively with good outcome.Asian Journal of Medical Sciences Vol.9(4) 2018 41-45

Hematoma extradural intracraniano

O hematoma extradural representa 1% a 5,5% das lesões intracranianas em pacientes com trauma cranioencefálico. Os objetivos desta pesquisa foram estudar descritivamente 162 casos de hematoma extradural e analisar o volume do hematoma em relação à sua localização, à idade do paciente e à presença de lesões intracranianas associadas. Foram estudados 162 casos de hematoma extradural traumáticos por tomografia computadorizada atendidos no Hospital Governador “João Alves Filho” (Aracaju-SE) entre 1994 e 2004. Para analise estatística, foram utilizados testes t-student, ANOVA com pós-teste de Tukey e curva de regressão linear. Os resultados foram significativos quando p &lt; 0,05. Vinte e nove vírgula seis porcento dos pacientes, tinham menos de 20 anos de idade, 67,3% tinham entre 20 e 59 anos e 3,1% tinham acima de 60 anos de idade. A relação masculino–feminino foi de 5.48:1. Na curva de regressão linear, não houve significância entre o volume do hematoma extradural e a idade de pacientes com 15 anos ou mais. Não houve diferença entre o volume do hematoma em pacientes com e sem lesão intracraniana associada. O volume do hematoma foi significativamente menor na região temporal em comparação às regiões frontotemporoparietal e temporoparietal, assim como na região frontal em relação à temporoparietal. Diante disso, conclui-se que: 1) A incidência de hematoma extradural foi maior em adultos jovens do sexo masculino; 2) Não há relação entre o volume do hematoma e a idade do paciente; 3) O volume do hematoma independe da presença de lesão intracraniana associada; 4) Há relação entre o volume do hematoma e sua localização, sendo o menor volume em região temporal

Conservative Plan for Post Traumatic Extradural Hematoma: Risk Factors Favouring Conversion to Surgery

Introduction: Extradural hematoma (EDH) is considered one of the most serious and recognized secondary insults of traumatic brain injury (TBI). We will analyse the data of cases required conversion from a conservative to a surgical management and identify the possible patient and disease related risk factors in such cases. Patients and Methods: This prospective study included 90 patients with traumatic EDH, admitted to the Neurotrauma department in Cairo University hospitals from March 2014 to August 2016. Their CT scans reveal EDH alone or with associated cerebral lesions initially fitting the criteria of conservative management. Results: The commonest site is frontal in 21 patients (23.3%), followed by parietotemporal in 18 patients (20%). While Posterior fossa hematomas occurred in 3 cases, which was the least common site (3.3%). The mean size of the EDH was 17.02 ml, with a standard deviation of 6.29 ml. The minimum size was 2 ml and a maximum of 28 ml. The cut off value of the size of the hematoma requiring conversion to a surgical management was 19 ml. Conclusion: Clear indications of EDH evacuation have been well known, however studying which risk factors are more liable to convert conservative management plan to evacuation is important. Increased caution and closer monitoring are required when the size of the hematoma is >19 ml or the hematoma is overlying a venous sinus. Unlike coagulopathy which was found to be a potential risk factor, but larger number study is needed.

Traumatic extradural lumbar haematoma due to a pathological metastatic vertebral body fracture L3. Case report and review of the literature

Abstract Spinal epidural haematoma (SEH) is a rare entity. We present the case of a 45 years old patient with lumbar epidural hematoma produced by a L3 vertebral tumoral (metastatic) fracture. Neurological status: cauda equina syndrome with sphincterian deficits, incomplete paraplegia (Frankel C), with neurological level L1. Emergency surgery was performed (L3-L2-bilateral laminectomy, L1 left laminectomy, posterior stabilization L2-L4 by titan screws) offering the possibility to progressive motor, sensitive and sphincterian deficites recovery. Abbreviations: Computer Tomography-CT, Magnetic resonance Imaging-MRI, Spinal epidural haematoma-SEH, Visual analogue scale of pain-VAS. Conclusion: We present a patient with a compressive subacute extradural haematoma, due to a traumatic fracture on a vertebral metastatic tumor who produced cauda equina syndrome. Surgical emergency intervention was mandatory for a good neurological outcome.

The impact of major trauma centre implementation on the pathways and outcome of traumatic intracranial extradural haematoma in a regional centre

Introduction: A new trauma care system with regional major trauma centres (MTC) was implemented on 1st April 2012 across England. We aimed to assess whether this has affected the referral pathways and mortality of patients undergoing emergency craniotomy for extradural haematoma (EDH), where clinical outcome is correlated with the time to intervention.Materials and methods: This was a retrospective cohort comparison study. All patients who had undergone evacuation of EDH from January 2011 to December 2013 were identified. Only those in whom a decision for emergency craniotomy had been made at the time of referral to the on-call neurosurgeon were included. The CRASH predicted risk of mortality was calculated for individual patients. Mortality was assessed at 14 days in order to compute standardised mortality ratios (SMR).Results: Overall, 65 patients underwent EDH evacuation during the study period (21 pre-MTC and 44 post-MTC). Of those, 43 emergency procedures according to the aforementioned definition were included for further analysis (13 pre-MTC, 30 post-MTC). The mean CRASH predicted risk of mortality was 0.21 for the pre-MTC cohort (95% CI: 0.07–0.34) and 0.094 for the post-MTC cohort (95% CI: 0.039–0.15; p = 0.052). There was no significant difference in the rate of secondary transfers before and after MTC implementation (9/13 vs. 23/30, p = 0.71). The mean interval from referral to operation was 198 min for the pre-MTC cohort (95% CI: 123–273) and 201 min for the post-MTC cohort (95% CI: 141–262; p = 0.95). The SMR was 0.37 for the pre-MTC cohort (95% CI: 0.02–1.81; 1 death) and 0.71 for the post-MTC cohort (95% CI: 0.12–2.34; 2 deaths).Conclusions: MTC implementation has not affected the time to operation or the mortality following EDH evacuation.

Traumatic Extradural Hematoma: Factors Affecting the Surgical Outcome

Objective: To determine the factors affecting surgical outcome of traumatic intracranial extradural hematoma in Civil Hospital Karachi. Head injury is a leading cause of death in young age group. Extradural hematoma, a complication of head injury, is often fatal if not treated in time. The surgical outcome of EDH is dependent upon many variables including preoperative GCS, time between injury and surgery, associated intracranial injuries, anisocoria and hematoma volume. In order to reduce the mortality near to nil, it is essential to determine the magnitude of effect of affecting factors on surgical outcome which will also help us in preoperative counseling and prioritizing the operative candidates. Study Design: Cross sectional study. Six months from 28th May 2012 to 27th November 2012. Materials and Methods: The study was conducted on the patients admitted through emergency and diagnosed as extradural hematoma. These patients underwent surgical evacuation of EDH on emergent basis and outcome was measured by Glasgow Outcome Scale (GOS) after 48 hours of surgery. Results: Using GOS, good surgical outcome was observed in 80.9% (157 out of 194) patients. Preoperative GCS, anisocoria, hematoma volume, associated intracranial injuries and time between injury and surgery were the factors affecting the outcome significantly (p value=0.000) while age and sex of the patient had no significant effect. Conclusion: Good surgical outcome is associated with patients with solitary extra dural hematoma of volume less than 60ml, preoperative GCS more than 8, absence of anisocoria and undergoing surgical evacuation within 6 hours of injury.

Outcome of Surgically Treated Traumatic Extradural Hematoma

Outcome of Surgically Treated Traumatic Extradural Hematoma

Traumatic extradural hematoma in childhood

This study was undertaken to assess the clinical and radiological characteristics of children with traumatic extradural hematoma (TEDH), and factors affecting the initial neurological status and outcome. Medical records of 269 consecutive children with TEDH from 2005 to 2012 were retrospectively reviewed, factors affecting the initial neurological status and outcomes were explored using univariate and multivariate analysis. There were 166 boys and 103 girls (average age: 7.0 years). Fall from a height (59 %) was the most common mechanism of head injury. With increasing age, an increase of motor-vehicle accident and assault was noted. Among the children 85.5 % experienced a Glasgow Coma Scale (GCS) of 13-15, 9.7 % with GCS 9-12, and 4.8 % with GCS 3-8. The main clinical manifestations were headache, vomiting and nausea, and conscious disturbance. The main locations were the temporal, temporoparietal, and frontal regions. The 97.4 % saw a favorable outcome, whereas 2.6 % had a poor outcome (overall mortality: 1.1 %). Many factors influenced the prognosis; the most important factors affecting prognosis were the initial neurological condition and secondary brain edema, while the initial neurological status were associated with pupillary abnormality, clinical progression, the number and volume of TEDH, and midline shift. Although the outcome was excellent in most cases, early diagnosis and surgical evacuation before irreversible brain damage was important to lower mortality for those massive TEDHs.

Postoperative Extradural Hematomas

Postoperative extradural hematoma (POEH) is a possible complication after head surgery, often neglected in the literature. In a single surgeon experience we found 13 cases of POEH (0.8%). We distinguished two subtypes: (1) larger hematomas (>40 cc) with typical features and overt clinical picture that always needed evacuation, and (2) smaller hematomas (<40 cc) with insidious clinical onset and different radiological features compared with traumatic and spontaneous extradural hematomas. On the basis of our experience, we propose that clinical picture and radiologic appearance lead the decision between conservative or interventional treatment of type II hematomas.

Análise epidemiológica de 210 casos de hematoma extradural traumático tratados cirurgicamente

To assess the epidemiology, clinical and radiological presentation of patients with traumatic extradural hematoma (EDH) undergoing neurosurgical procedures. We performed a chart review of 210 patients admitted to the emergency department with EDH diagnosed by CT scan and surgically treated between August 1998 and January 2008. Variables analyzed were: age, gender, clinical and radiological presentation, mechanism of injury and neurological status at discharge from hospital. In 49.2% trauma mechanism was fall; 89.2% of patients were male, 49.7% of cases had a Glasgow Coma Scale (GCS) between 13 and 15; 61% of patients had age between 20 and 49 years; the location of EDH was the temporo-parietal and temporal in 26.5% and 19.6% of the cases, respectively; 32.8% had associated intracranial lesions, with skull fractures seen in around 45% of cases; 76.2% of surgically treated patients were discharged with minimal or no neurologic deficit. We observed that, in the study population, EDH appears more often in males, in the fourth decade of life, and is more related to falls. On admission, GCS was observed between 13 and 15 and it is appropriate to mention the involvement of the temporo-parietal region in most cases. We believe that knowledge of the epidemiology of traumatic epidural hematoma can assist in developing public health measures aimed at prevention and early identification of this disease in the population.

Cerebral venous sinus thrombosis complicating traumatic head injury

Cerebral venous sinus thrombosis (CVST) is a rare complication of traumatic head injury. Here we present a patient with traumatic extradural haematoma successfully evacuated with good clinical recovery. However, the patient then deteriorated and died. The cause, at post mortem, was a propagating CVST, sustained at the time of head injury. CVST, although rare, is therefore an important cause of deterioration in traumatic head injury. This patient with CVST is unique in that CVST was not considered as a diagnosis in the face of more obvious pathology and was responsible for late deterioration. We discuss the potential difficulties in both the detection and management of such a complication, particularly in association with extradural haematoma.

Traumatic Extradural Hematoma – Our Comparative Experience between Conservative and Surgical Management in Rural India

Background: To study and compare the role of conservative management and surgical intervention in traumatic extradural hematoma (EDH) in rural India. Setting: Government Medical College, Miraj, Maharashtra state, India. Materials and methods: 240 trauma patients diagnosed as extradural hematoma on CT scan were managed during 2 year period. Outcomes: Comparative role of conservative management and surgical intervention were studied. Results: Out of these 240 patients admitted 134 were managed conservatively, 106 cases were operated upon. 62 were operated upon immediately and 44 were operated upon as delayed. There were 2 deaths and 8 had poor outcome in this group of patients. Conclusion: It is stressed that small size 12 and locations other than temporal area are the criteria for conservative management. 44 patients out of 178 were needed to be treated surgically during the course of conservative management due to neuro deterioration, increase in size of hematoma on CT, bradycardia, hemiparesis, pupillary abnormalities, delay in referral and only 18% had poor outcome. A strict vigilance is to be kept for clinical deterioration and various reasons mentioned above are to be kept in mind and patients should be subjected to repeated CT scan. Early diagnosis and immediate surgical intervention had good outcome, which shows the rewarding results of early diagnosis and intervention.

Traumatic extradural hematoma in Enugu, Nigeria

Aim:Acute traumatic extradural hematoma (EDH) is life threatening and requires prompt intervention. This is a study of incidence and outcome of consecutive patients with EDH managed in Enugu, Nigeria against a background of delayed referral.Materials and Methods:We retrospectively examined all consecutive trauma cases managed between 2003 and 2009 and analyzed patients with acute traumatic extradural hematoma in isolation or in combination with other intra cranial lesions. Age, sex, cause of injury, time of presentation, Glasgow Coma Score (GCS), pupil reactivity, treatment and clinical outcomes were determined.Results:Of 817 head injuries, 69 (8.4%) had EDH, a mean of 9.9 patients per year. Males were 57 (83%) and females 12 (17%). Peak age incidences were the second and third decades of life, with a mean age of 30.2 years. Causes were road traffic accidents (57%), assault (22%) and falls (9%). Twenty-six (38%) patients presented within 24 h of injury and only one patient presented within 4 h. The average time lag before presentation was 94.2 h. At presentation 39% had GCS of 13-15, 27% had 9-12 and 34% had 3-8. The most common location of hematoma was temporal (27.5%). Forty (59%) patients had surgery while 14 (20%) were managed conservatively. Ten patients (14.5%) died and of these 70% had GCS <8 and 60% had a seizure.Conclusion:We conclude that early appropriate treatment of EDH results in good high quality survival (Glasgow Outcome Score 4 or 5). Low GCS should not be an absolute contraindication for surgery. Seizure prophylaxis should be considered in patients with GCS <8.

Is management of spontaneous intracranial extradural hematoma in chronic renal failure is different with traumatic extradural hematoma — Case report and review of literature

Intracranial extradural hematoma is commonly associated with head trauma. Spontaneous EDH is a rare entity and associated with various co morbid conditions. Chronic renal failure (CRF) is one of them. In case of CRF, spontaneous EDH has been reported in those patients who were either on hemodialysis or had long history of CRF. We report a case of concurrently asymptomatic chronic renal failure that developed spontaneous EDH with neurological deficits and during investigation, diagnosed to have acute on chronic renal failure. Investigation and management is discussed in the report.

Traumatic extradural hematoma - role of non-surgical management and reasons for conversion.

To study the role of conservative management and various reasons for conversion to surgical intervention in traumatic extradural hematoma (EDH). Government Medical College Jammu. One hundred-twenty trauma patients diagnosed as extradural hematoma on CT scan were managed during 1 year period. Role of conservative management and various reasons for conversion to surgical intervention were studied. Out of these 120 patients admitted 67 were managed conservatively, 53 cases were operated upon. 31 were operated upon immediately and 22 were operated upon as delayed. There was 1 death and 4 had poor outcome in this group of patients. It is stressed that small size <10 ml, GCS >12 and locations other than temporal area are the criteria for conservative management. Twenty-two patients out of 89 were needed to be treated surgically during the course of conservative management due to neurodeterioration, increase in size of hematoma on CT, bradycardia, hemiparesis, pupillary abnormalities, delay in referral and only 18% had poor outcome. A strict vigilance is to be kept for clinical deterioration and various reasons mentioned above are to be kept in mind and patients should be subjected to repeated CT scan. Early diagnosis and immediate surgical intervention had good outcome, which shows the fruitful results of early diagnosis and intervention.

Traumatic subfrontal extradural hematoma presenting with proptosis

Traumatic subfrontal extradural hematoma presenting with proptosis