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Bilateral asynchronous acute epidural hematoma : a case report.

Eftekhar B, Ketabchi E, Ghodsi M, Esmaeeli B - BMC Emerg Med (2003)

Bottom Line: The hematoma was evacuated, but the patient did not improve afterwards.Postoperatively, the patient recovered completely.Intraoperative brain swelling can be considered as a clue for the development of contralateral hematoma.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, Sina Hospital, Tehran University, Tehran, IRAN. eftekhar@sina.tums.ac.ir

ABSTRACT
BACKGROUND: Bilateral 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 PRESENTATION: An 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. CONCLUSIONS: This 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.

No MeSH data available.


Related in: MedlinePlus

Initial Brain CT scan of the patient. It shows a large right frontotemporal epidural hematoma with midline shift and a small hemorrhagic contusion in the left temporal. There was no definite sign of the contra lateral hematoma at this stage.
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Figure 1: Initial Brain CT scan of the patient. It shows a large right frontotemporal epidural hematoma with midline shift and a small hemorrhagic contusion in the left temporal. There was no definite sign of the contra lateral hematoma at this stage.

Mentions: An 18-year-old male worker was admitted to our hospital after a fall from a 3-meter height. Upon arrival he was completely conscious and without neurological deficit. Four hours after the accident, he started vomiting and his consciousness deteriorated. An emergency CT scan was performed and showed a large right frontotemporal epidural hematoma with midline shift and a small hemorrhagic contusion in the left temporal. Although a bilateral frontal diastatic fracture could also be noticed, there was no definite sign of the contra lateral hematoma at that stage considering the quality of the CT scan (Fig. 1). He was transferred to the operating room, while his level of consciousness was deteriorated and his right eye was getting middilated. During the operation, there was significant bleeding from one of the branches of the right middle meningeal artery. During the operation and after the bleeding was controlled on the right side, the brain started to swell. This swelling did not respond to any measures used by our anesthetists. Since after the operation the patient remained unconscious, a new CT scan was performed, postoperatively (Fig. 2). As can be seen a contra lateral temporoparietal epidural hematoma had been developed during this period. Second craniotomy and evacuation of the hematoma on the left side was performed. As was expected, the patient improved postoperatively. Two weeks later, he was completely conscious without any neurological deficit.


Bilateral asynchronous acute epidural hematoma : a case report.

Eftekhar B, Ketabchi E, Ghodsi M, Esmaeeli B - BMC Emerg Med (2003)

Initial Brain CT scan of the patient. It shows a large right frontotemporal epidural hematoma with midline shift and a small hemorrhagic contusion in the left temporal. There was no definite sign of the contra lateral hematoma at this stage.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC317469&req=5

Figure 1: Initial Brain CT scan of the patient. It shows a large right frontotemporal epidural hematoma with midline shift and a small hemorrhagic contusion in the left temporal. There was no definite sign of the contra lateral hematoma at this stage.
Mentions: An 18-year-old male worker was admitted to our hospital after a fall from a 3-meter height. Upon arrival he was completely conscious and without neurological deficit. Four hours after the accident, he started vomiting and his consciousness deteriorated. An emergency CT scan was performed and showed a large right frontotemporal epidural hematoma with midline shift and a small hemorrhagic contusion in the left temporal. Although a bilateral frontal diastatic fracture could also be noticed, there was no definite sign of the contra lateral hematoma at that stage considering the quality of the CT scan (Fig. 1). He was transferred to the operating room, while his level of consciousness was deteriorated and his right eye was getting middilated. During the operation, there was significant bleeding from one of the branches of the right middle meningeal artery. During the operation and after the bleeding was controlled on the right side, the brain started to swell. This swelling did not respond to any measures used by our anesthetists. Since after the operation the patient remained unconscious, a new CT scan was performed, postoperatively (Fig. 2). As can be seen a contra lateral temporoparietal epidural hematoma had been developed during this period. Second craniotomy and evacuation of the hematoma on the left side was performed. As was expected, the patient improved postoperatively. Two weeks later, he was completely conscious without any neurological deficit.

Bottom Line: The hematoma was evacuated, but the patient did not improve afterwards.Postoperatively, the patient recovered completely.Intraoperative brain swelling can be considered as a clue for the development of contralateral hematoma.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, Sina Hospital, Tehran University, Tehran, IRAN. eftekhar@sina.tums.ac.ir

ABSTRACT
BACKGROUND: Bilateral 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 PRESENTATION: An 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. CONCLUSIONS: This 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.

No MeSH data available.


Related in: MedlinePlus