Delayed Sequential Multiple Extradural Hematomas – Case Report and Review of Literature

Abstract

Multiple extradural hematomas (EDH) >= 3 are an uncommon occurrence especially when they arise sequentially over a period of time. We present a case of delayed multiple EDH in a patient with trauma. A 31-year-old male presented to us with a moderate head injury (GCS-9). CT revealed diffuse axonal injury. He was electively ventilated and an intracranial pressure (ICP) monitor was placed. ICP increased over the next few hours. Repeat CT scan (8 hours after injury) revealed bilateral EDH (Right parietal and Left parieto occipital). He underwent emergency craniotomy and evacuation of both the EDH's. Subsequently a repeat CT scan (6 hours later) revealed a right parieto occipital EDH for which he underwent craniotomy and evacuation. Subsequently the patient made an uneventful recovery. Careful monitoring and appropriate management gives excellent results. We also review the relevant literature.

Key words

Multiple - sequential extradural hematoma

• References

• 1 Huda MF, Mohanty S, Sharma V, Tiwari Y, Choudhary A, Singh VP. Double extradural hematoma: An analysis of 46 cases. Neurol India 52 2004; 450-452
• 2 Frank E, Berger TS, Tew Jr JM. Bilateral epidural hematomas. Surg Neurol 17 1982; 218-222
• 3 Gurdjian ES. Recent advances in the study of mechanism of impact injury of the head. A summary Clin Neurol 11 1972; 1-42
• 4 Dharkar SR, Bhargava N. Bilateral epidural hematoma. Acta Neurochir 110 1991; 29-31
• 5 Gorgulu A, Cobanoglu S, Armagan S, Karabagli H, Tevruz M. Bilateral epidural hematoma. Neurosurg Rev 23 2000; 30-33
• 6 Gupta SK, Tandon SC, Mohanty S, Asthana S, Sharma S. Bilateral traumatic extradural hematomas: report of 12 cases with a review of literature. Clin Neurol Neurosurg 94 1992; 127-131
• 7 McCarty CS, Homing ED, Weaver EN. Bilateral extradural hematoma. J Neurosurg 05 1948; 88-90
• 8 Rochat P, Johannesson HH, Poulsgard L, Bogeskov L. Sequentially evolved bilateral epidural haematoma. Clin Neurol Neurosurg 105 2002; 39-41
• 9 Sharma V, Newton G. Bilateral extradural hematoma. Neurol India 38 1990; 455-459
• 3 Gurdjian ES. Recent advances in the study of mechanism of impact injury of the head. A summary.