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47% of patients with moderate sized SCH need surgical evacuation. EVD insertion not only helps in ICP management but also includes the ability to gradually decompress ventricular system by varying the outflow pressure. Apart from radiologic findings, ICP measurement should be a guideline in management decisions.

Introduction: Intracranial epidural haematoma, (EDH) is a collection of blood between the skull and dura mater due to head injury. It is considered to be the most serious complication of head injury requiring immediate diagnosis and surgical intervention. Background: The aim of our study was to present the outcome of consecutive patients with Acute EDH managed surgically & to prove the high risk of death or permanent brain damage without prompt surgical intervention. Method: In this study we retrospectively examined all consecutive head injury cases managed between September 2014 & September 2015 and diagnosed with acute traumatic epidural hematoma in isolation or in combination with intra cranial lesions. Age, sex, mechanism of injury, time of presentation, Glasgow Coma Score (GCS), pupil reactivity, time of surgery and clinical outcomes were evaluated. Results: Out of 31 cases 87%, (n=27) were males and 13 %,(n=4) were females. The mean age was 17.75 years. 74% (n=23) patients under the age of 25years. The most common mode of injury was road traffic accident 48%, (n=15) followed by fall 42%, (n=13). The mortality rate was 6% (n=2). The time interval between trauma & operation of both patients who died were more than 8 hours. Conclusions: An acute epidural hematoma is an emergency condition, the diagnosis of the EDH must be promptly made by CT scan and the patient should be immediately transferred into a neurosurgical centre, Early surgical intervention is associated with the best outcome.

Uncommon mode of presentation of head injury [UPHI] in children needs to be highlighted to create awareness amongst the treating surgeons and parents to prevent injuries to the growing brain. Records of 21 children aged between 6 months and 7 years admitted with UPHI between 2001 and 2003 were analyzed. Out of 21 children, 5 were ejected from their cars following head on collision, 4 children were hit by falling television sets, 3 were injured while reversing cars, 3 were hit by running ceiling fans, 2 were hit by siblings out of jealousy, 2 fell from laps of their teenaged mothers, 1 fell from camel back and 1 was victim of abuse. Nine children (42.8%) sustained severe head injury [SHI] presenting as diffuse brain injury, brain edema, acute subdural hematomas, or multiple contusions. Five (23.8%) children had moderate head injury [HI presenting with depressed fractures with associated contusions (2 cases) epidural hematomas, calavarial fractures, seizures and patient of child abuse had depressed with small epidural hematoma with subdural effusion. Seven children (33.3%) with mild HI showed depressed fractures associated with small epidural hematomas. Five out of 9 SHI patients died (55.6%) and four had moderate outcome (44.4%). Of the five patients with moderate HI two had moderate outcome (40%) and the remaining 60% had good outcome. Patients with minor injury became normal. If care is taken against above highlighted factors then mortality and morbidity can be reduced.