Epidural hematoma

Case contributed by Dr Mohamed Mahmoud Elthokapy

Presentation

Decreased level of consciousness after a motor vehicle accident.

Patient Data

Age: 8 years
Gender: Male
CT

A fairly defined extra-axial epidural bi-convex (lentiform shaped) collection is seen related to the right frontal region. It exhibits a predominantly high attenuation value suggesting a recent epidural hematoma. It measures about 7.3 cm long and about 30 mm in its maximum thickness. It exerts a mass effect in form of effacement of the underlying cortical sulci, compression of right lateral ventricle frontal horn as well as minimal contra-lateral midline shift.

Post-op (10 hours later)

CT

There are changes related to right frontal craniotomy bone flap with the evacuation of an underlying previously seen epidural hematoma which shows a significant regressive course regarding the amount and mass effect with the residual minimal heterogeneous collection as well as gas foci inside (pneumocephalus).

Minimal subgaleal thickening/ collection with small gas locules, subcutaneous drain in situ, and surgical sutures (post-operative changes).

Case Discussion

Typical appearance of an epidural hematoma with rapid surgical intervention resulting in good decompression.

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