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CT scan showing an increasing subdural fluid collection with mild mass effect and some effacement of lateral ventricle.
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fig1: CT scan showing an increasing subdural fluid collection with mild mass effect and some effacement of lateral ventricle.

Mentions: A 38-year-old man suffered blunt head trauma in an automobile accident and was admitted to a local neurosurgical hospital. On admission, the patient was drowsy and his Glasgow Coma Scale score was 6, both pupils were isocoric and reactive to light. The patient underwent evaluation with computed tomography (CT) scan and basic laboratory studies. The patient had diffuse axonal injury grade III and was admitted in an intensive care unit(ICU). Two weeks later patient evolved with Glasgow Outcome Scale (GOS) 2. Three weeks after trauma patient had worsening level of consciousness, and right hemiparesis grade IV. A control CT scan was performed that showed an increasing subdural fluid collection with mild mass effect and some effacement of the left lateral ventricle (Figure 1). The fluid collection was most consistent with subdural hygroma unassociated with subdural hematoma. We perform a frontal trepanation with fast drainage of an extreme hypertensive subdural collection with citrine aspect. In postoperative patient return to ICU and in next day the patient remained in coma, underwent another CT scan that showed a large left parieto-occipital AEH (Figure 2). The patient was taken to the operating room. Craniotomy and evacuation of the hematoma were performed. Computed tomography after surgery revealed good surgical result. In hospital discharge patient presented GOS 3.

Remote Postoperative Epidural Hematoma after Subdural Hygroma Drainage

Paiva WS, Oliveira AM, de Andrade AF, Brock RS, Teixeira MJ - Case Rep Med (2010)

Bottom Line: Craniotomy and evacuation of the hematoma were performed.Conclusion.The mechanism of remote postoperative AEH formation is unclear.

Affiliation: Division of Neurosurgery, University of São Paulo, 01416001, Brazil.

ABSTRACT
Objective. Subdural hygroma is reported to occur in 5%-20% of all patients with closed head trauma, the treatment is controversial and in symptomatic cases surgical drainage is need. We report on a new case with remote acute epidural hematoma (AEH) after subdural hygroma drainage. Case Presentation. A 38-year-old man suffered blunt head trauma and had diffuse axonal injury grade III in CT scan. A CT scan that was late performed showed an increasing subdural fluid collection with mild mass effect and some effacement of the left lateral ventricle. We perform a trepanation with drainage of a hypertensive subdural collection with citrine aspect. Postoperative tomography demonstrated a large left AEH. Craniotomy and evacuation of the hematoma were performed. Conclusion. The mechanism of remote postoperative AEH formation is unclear. Complete reliance on neurologic monitoring, trust in an early CT scan, and a relative complacency after an apparently successful initial surgery for hygroma drainage may delay the diagnosis of this postoperative AEH.

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