Introduction: Extradural hematomas (EDHs) accounts for approximately 2% of patients following head trauma and 5-15% of patients with fatal head injuries. When indicated, the standard surgical management consists of evacuation of the hematoma via craniotomy. Intraoperative development of acute extradural hematoma (AEDH) on the contralateral side following evacuation of acute extradural hematoma is uncommon and very few cases have been reported.
Case report: We report a case of 28 year-old-male who suffered from a severe head injury following assault and diagnosed as acute extradural hematoma over right fronto-parietal region with midline shift towards left. Patient underwent emergency craniotomy with acute EDH evacuation. Following evacuation of acute EDH the duramater was tense which was unusual finding. With anticipation of underling acute SDH small durotomy was done, but there were no sub dural hematoma. Bone flap were repositioned and closure were done. Patient was shifted for NCCT head from OT, which revealed 2.7cm acute EDH over left frantoparietal region. Patient was again shifted back to OT and left frontoparietal craniotomy with evacuation of hematoma was done. Postoperative NCCT head was satisfactory. However, the patient remained severely disabled.
Conclusion: Formation of contralateral EDH after AEDH surgery is a rare but potentially dangerous complication. A high degree of suspicion should be kept for contralateral extradural hematoma if during surgery there is tense duramater following AEDH evacuation. We would advise urgent NCCT head especially if a fracture is demonstrated on the preoperative CT scan on contralateral side. This would save some invaluable time, which may help in changing the outcome in some of the patients.
1. Alappat JP, Baiju, Praveen, Jaya kumar K, Sanalkumar P. Delayed extradural hematoma : a case report. Neurol India 2002; 50:313-5.
2. Borovich B, Braun J, GUilburd JN, Zaaroor M, Michich M, Levy L, Lemberger A, Grushkiewicz I, Feinsod M. Delayed onset of traumatic extradural hematoma. J Neurosurg.1985;63:30-4.
3. Borah N, Dutta D, Baishya BK, Hussain Z. Contralateral extradural hematoma formation following evacuation of chronic subdural hematoma- A case report and review of literature. Indian Journal of Neurotrauma. 2015;I-3.
4. Eftekhar B, Ketabchi E, Ghodsi M, Esmaeeli B. Bilateral asynchronous acute epidural hematoma: a case report. BMC Emerg Med. 2003 Dec 30;3(1):1.
5. Feuerman T, Wackym PA, Gade GF, Lanman T. Becker D. Intraoperative development of contralateral epidural hematoma during evacuation of traumatic extraaxial hematoma. Neurosurgery 1988; 23: 480-4.
6. Matsuno A, Katayama H, Wada H, et al. Significance of consecutive bilateral surgeries for patients with acute subdural hematoma who develop contralateral acute epior subdural hematoma. Surg Neurol 2003; 60:23-30.
7. Mohindra S, Mukherjee KK, Gupta R, et al. Decompressive surgery for acute subdural haematoma leading to contralateral extradural haematoma: a report of two cases and review of literature. Br J Neurosurg 2005;19:490–4.
8. Rajput DK, Kamboj R, Srivastav AK, Kaval P, Kumar R. Is management of spontaneous intracranial extradural hematoma in chronic renal failure is different with traumatic extradural hematoma - Case report and review of literature: Indian Journal of Neurotrauma. 2010; 7:81-84.
9. Singh M, Ahmad F U, Mahapatra AK. Intraoperative development of contralateral extradural hematoma during evacuation of traumatic acute subdural hematoma: A rare cause of malignant brain bulge during surgery. Indian journal of Neurotrauma 2005; 2:139-140.
10. Wani AA, Dhar A, Laherwal M, Ramzan AU, Malik NK, Nizami FA, Wani MA. Bilateral sequential developed asynchronous extradural haematomas. Indian Journal of Neurotrauma 2010,7,79-80.