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Development of a delayed acute epidural hematoma following contralateral epidural hematoma evacuation: case report and review of literature

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Abstract

The formation of a post-traumatic delayed epidural hematoma (DEDH) is a rare but well-described complication in the literature. It is defined as an extradural bleeding not evident at the first computed tomography (CT) scan performed after trauma, but evidenced by further radiological evaluations. The most supported hypothesis about the mechanism responsible for the formation of a DEDH concerns above all the loss of a tamponade effect given by the reduction of intracranial pressure with medical or surgical treatment. A 30-year-old man was admitted to the emergency department with an epidural hematoma (EDH) associated with a linear calvarial bitemporal coronal fracture. A few hours after the surgical procedure for hematoma evacuation, the patient developed a DEDH contralateral to the site of surgical procedure. The literature review identified other 27 analogue cases. The presence of a calvarial fracture contralateral to the site of a craniotomy and the intraoperative brain swelling during EDH removal are suspicious for the development of DEDH. A CT scan has to be urgently performed in this situation. The timing of postoperative radiological examinations after EDH removal has to consider possible complications and has to be balanced on the basis of patient’s clinical condition and neuroradiological data, such as skull fractures or intraoperative anomalies. The development of a DEDH after the surgical removal of an EDH is a rare event, characterized by a high mortality rate. DEDH develops preferentially on the contralateral side and with a concomitant skull fracture.

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Abbreviations

DEDH:

Delayed epidural hematoma

EDH:

Epidural hematoma

CT:

Computed tomography

ICP:

Intracranial pressure

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Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Neurosurgery, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy

    Fabrizio Gregori, Giorgio Santoro, Manolo Piccirilli & Maurizio Domenicucci

  2. Neurosurgery, IRCCS Neuromed, Pozzilli, IS, Italy

    Cristina Mancarella

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  1. Fabrizio Gregori
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  2. Giorgio Santoro
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  3. Cristina Mancarella
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  4. Manolo Piccirilli
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  5. Maurizio Domenicucci
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Correspondence to Fabrizio Gregori.

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Gregori, F., Santoro, G., Mancarella, C. et al. Development of a delayed acute epidural hematoma following contralateral epidural hematoma evacuation: case report and review of literature. Acta Neurol Belg 119, 15–20 (2019). https://doi.org/10.1007/s13760-018-1049-y

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