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.