Romanian Neurosurgery (Jun 2024)

Acute synchronous bilateral extradural hematoma, a scarcely reported, rare entity

  • Vibhu Shankar Parashar,
  • Pankaj Arora,
  • Ritesh Garg,
  • Priyanka Aswal

Journal volume & issue
Vol. 38, no. 2

Abstract

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Objective: Extradural hematomas (EDHs) are contact injuries resulting from blunt trauma to the skull. It may be unilateral or bilateral. Bilateral acute extradural hematoma (EDH) was rarely reported before the advent of computed tomography. Mortality rates vary from 10.0%-40.0% and are an index of alertness and efficiency of health care and hospital set-up. EDH is an injury with preventable mortality in most cases. Bilateral acute extradural hematomas no longer confer high mortality of pre-CT era because of early diagnosis on CT, and prompt neurosurgical intervention. We present our experience with Bilateral EDH cases with an aim to investigate clinical, GCS score, and radiological features and also to analyse outcomes in these patients. Material and methods: We analyzed cases of EDH who presented at our centre from January 2023 to December 2023 and further investigated ten cases of bilateral EDH. All the patients were examined clinically and a plain computerized tomography scan of the head was performed. The clinical details of all patients, GCS at admission and discharge, radiological findings on CT and neurosurgical intervention performed, and GOS (Glasgow outcome score) were noted. Results: Road traffic accident was the reason for traumatic brain injury in all the cases. The GCS at admission was between 13–15 in 2 patients, 8–12 in 6 and 3–7 in 2 patients. Bilateral EDH was found in all of our patients .9 out of 10 cases were males. On CT head underlying fracture was seen in all cases. The localization of epidural hematomas in CT scans was bifrontal in four of the cases. All cases were treated with surgical management. The GOS Score was 5 in eight of the patients. Conclusion: Posttraumatic bilateral acute extradural hematoma is a rare entity, but now does not show the high mortality previously seen in the preCT era. This is due to early radiological diagnosis on CT and profuse monitoring combined with expeditious operative procedures.

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