- Neurosurgical Department, Yalta City Hospital, Yalta, Crimea, Ukraine
Volodymyr O. Solomiichuk
Neurosurgical Department, Yalta City Hospital, Yalta, Crimea, Ukraine
DOI:10.4103/2152-7806.119234Copyright: © 2013 Solomiichuk VO This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Solomiichuk VO, Drizhdov KI. Contralateral delayed epidural hematoma following intracerebral hematoma surgery. Surg Neurol Int 03-Oct-2013;4:134
How to cite this URL: Solomiichuk VO, Drizhdov KI. Contralateral delayed epidural hematoma following intracerebral hematoma surgery. Surg Neurol Int 03-Oct-2013;4:134. Available from: http://sni.wpengine.com/surgicalint_articles/contralateral-delayed-epidural-hematoma-following-intracerebral-hematoma-surgery/
Background:Delayed epidural hematoma (EDH) is an uncommon finding in patients after intracranial hematomas evacuation. It occurs in 6.7-7.4% of cases. A total of 29 reports were found in literature. Between them were no cases of delayed contralateral EDH after intracerebral hematoma evacuation.
Case Description:This paper represents a clinical case of a 28-year-old male patient with opened penetrating head injury, who underwent left frontal lobe intracerebral hematoma evacuation and one day later a contralateral EDH was found and successfully surgically treated.
Conclusion:Contralateral EDH is a life-threatening neurosurgical emergency case, which can occur during first 24 hours after decompressive craniectomy. Control CT scans must be performed next day after the operation to verify and treat contralateral EDH timely.
Keywords: Decompressive craniectomy, epidural hematoma, head injury, postoperative hemorrhage
Delayed epidural hematoma (EDH) is an uncommon finding in patients after intracranial hematomas evacuation. Contralateral intracranial hematoma develops in 7.4% of cases after decompressive surgery[
The pathophysiology of delayed EDH is debated. Conventional wisdom says that in most cases the source of the bleeding exists at the time of the trauma, but the protective mechanisms prevent immediate appearance of the hematoma.[
A 28-year-old right-handed male with trauma signs on his head (a wound in his occipital region, nasal hemoliquorrhea, right-sided otohemoliquorrhea) was admitted to Yalta City Hospital after he felt down while riding a skateboard. On admission, he was Glasgow coma scale (GCS) 5 with left dilated pupil.
CT scans showed intracerebral traumatic hematoma in the left frontal lobe, 6 mm midline shift, right temporal bone fracture and a small pneumocephalus in sellar region [
Performed operation: left-sided hemicraniectomy through “trauma-flap” incision, evacuation of traumatic intracerebral hematoma in left frontal lobe. Intraoperatively an acute brain swelling occurred. Patient was transferred to ICU after the operation. One day after the operation, right-sided anisocoria occurred and a contralateral EDH with 10 mm of midline shifting was found at the control CT scans [
Patient underwent decompressive craniectomy in the right temporo-parietal region and evacuation of EDH about 100 cc in volume.
One day later there were no signs of residual hematoma on CT scans [
At the fifth day after the operation, percutaneous tracheostomy was performed. Patient was comatose 19 days after admitting to the hospital. He underwent conservative treatment of brain edema. After that control CT scans were performed [
Next day patient became apallic and 7 days later akinetic mutism was found.
At the 32nd day in the hospital, he was transferred from the intensive care unit (ICU) into the neurosurgical department.
One month later patient was awake and spoke with single separated words.
On 76th day in the hospital the CT scans were performed with 1 mm collimation for the titanium mesh implants and stereolithographic models development [
At his 2 month follow-up, he had neurological deficit of left-sided spastic hemiparesis, anosognosia, right-sided convergent strabismus.
Postoperative period was uneventful and in 15 days patient was sent to rehabilitation.
CT scans in a month after the cranioplasty showed brain expansion to its original shape [
Considering that the reduction of intracranial pressure by removing the intracranial hematoma or/and performing decompressive craniectomy is a predisposing factor for development of contralateral EDH, it is recommended to perform CT scans during the first day after surgery to exclude contralateral EDH development, which can cause devastating consequences such as deep neurologic deficit, apallic syndrome, and even death.
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