Introduction An acute bilateral extradural hematoma is an uncommon presentation of a traumatic head injury; however, it leads to higher mortality rate than an acute unilateral hematoma. A delayed epidural hematoma (DEDH) is a hematoma not present on the initial computed tomography (CT) scan but is found on a subsequent CT scan. While reviewing the literature, we could not find recently published papers considering supratentorial DEDH after primary operated contralateral epidural hematoma. Case outline A comatose 14-year-old male patient with Glasgow Coma Scale score of 4 and the right mydriatic pupil on the side of the blunt trauma to the head was admitted to the intensive care unit after he had survived a traffic accident. The initial brain CT scan showed an acute temporoparietal epidural hematoma on the right side of the cranium, with impressive midline shift and bilateral linear skull fracture. Surgery was performed and an intracranial pressure (ICP) monitor was implanted, which showed increased values of ICP. A control brain CT scan performed within 24 hours showed a new contralateral occipitoparietal epidural hematoma. Another operation was performed. A second, control CT brain scan showed favorable findings. The patient was transferred after 25 days to the rehabilitation center, with the disability rating score of 11, which was reduced to 1 after three months. Conclusion A contralateral DEDH is a life-threatening neurosurgical emergency case which can occur during the first 24 hours after decompressive craniectomy. Control CT scans should be performed one day after the operation in order to verify and treat DEDH timely. A high degree of vigilance and ICP monitoring is recommended in these cases, especially after surgical decompression.
Skull fractures occur as the result of the effect of kinetic forces and represent discontinuity of the bones of the skull. They can be opened and closed affecting tissues; linear, diastatic, comminuted affecting cranial level; or depressed ones often leading to injuries of meninx, brain tissue with different types of intracranial bleeding. The paper presents a 56-year old male patient who suffered severe craniocerebral injury of the frontal region including orbit while operating the wood processing machine. The injury manifested as scalp damage, expressed-depressed open fracture of frontal-orbital region with cerebrospinal fluid leak. Computerized tomography of the brain showed the presence of epidural, subdural, and intracerebral hematoma with mass effect. The injuries were surgically treated, hematomas evacuated, and skull defect was reconstructed by previous plasticizing the dura in order to stop cerebrospinal fluid leak In the reconstruction of the multifragmentary fracture, a star titanium implant was used, but significant implantation of artificial material was not performed due to already contaminated wound and the possibility of a subsequent infection.
Duration of intracranial pressure (ICP) monitoring depends on the clinician`s necessity for the data that influence type and length of the management of intracranial hypertension (ICHT). On the other hand, it is also affected by the possibility of the development of the infection, which is very often fatal when it occurrs in the central nervous system. A prospective study of the 32 patients with severe brain trauma (SBT) that had intracranial pressure (ICP) monitoring is presented in here. There were 22 patients with intracranial hypertension (ICHT) and 10 without it. In the ICHT group, the monitoring lasted 5.81 ± 2.70 and 4.45 ± 1.81 in the control group. We have not found a significant difference in the duration of the ICP monitoring between two groups (t = 1.71, p > 0.05). Patients with ICHT had significantly shorter survival than the control group (p = 0.04). It seems that need for prolonged monitoring of the patients with ICHT is suppressed by their shorter survival, comparing to brain-injured patients with normal intracranial pressure.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.