Delayed Extradural Hematoma Occurring After Evacuation Of Acute
Contralateral Extradural Hematoma: Case Report and Literature Review

Introduction:  Traumatic head injuries resulting in extradural hematoma (EDH) occur in about 2% of  patients. The development of EDH on the opposite side is an infrequent complication that has  been documented in several case reports.  

Method: This case report presents an unusual occurrence of delayed extradural hematoma  (EDH) after the surgical evacuation of an acute contralateral EDH. A 22-year-old patient,  involved in a high-velocity traffic accident, initially presented with a Glasgow Coma Scale of  12, significant agitation, and right anisocoria. Initial imaging revealed a substantial right  frontal EDH, prompting immediate evacuation. Postoperatively, the patient developed left  anisocoria, prompting a repeat brain CT scan that revealed a left frontal EDH. Surgical  intervention was again necessary for evacuation, with the source of bleeding identified as  dural. The patient recovered well postoperatively, underscoring the importance of vigilant  monitoring and prompt intervention in managing EDH cases, particularly given the potential  for delayed complications. This case underscores the intricacies and challenges associated  with traumatic brain injury management, emphasizing the necessity for comprehensive  evaluation and timely surgical intervention to mitigate adverse outcomes.  

Conclusion: The diagnosis of delayed onset extradural hematoma (EDH) arises when the  initial computed tomography scan appears negative or is conducted early, while subsequent  CT scans, performed to evaluate clinical or intracranial pressure (ICP) deterioration, reveal  the presence of an EDH. Identifying this condition necessitates a heightened suspicion,  considering the injury mechanism and fracture patterns. Additionally, alterations in pupillary  size, elevated intracranial pressure, and intraoperative brain bulging provide further clues to  contralateral bleeding. Neurological deterioration may or may not coincide with delayed EDH  presentation. Early postoperative non-contrast CT scans within 24 hours are advised to detect  this complication, irrespective of neurological status.  

Keys word: Extradural hematoma, Delayed onset, Contralateral hematoma, Traumatic brain  injury