Presentation
Motor vehicle collision.
Patient Data
Massive bifrontal convex extradural hematomas. Severe mass effect resulting in compression of brain parenchyma, hydrocephalus and uncal herniation.
Scattered small petechial hemorrhages, largest in the right pons.
Right posterior temporal and occipital infarcts. Medial left temporal infarct.
Case Discussion
Very large bifrontal convex extradural hematomas following head trauma. There is no skull fracture to account for the hemorrhage. The bleeding vessel is most likely the anterior superior sagittal sinus (venous epidural), which would account for the bifrontal distribution (midline vessel bleeding and dissecting through both frontal spaces symmetrically). There are uncal herniation and compression of the posterior circulation resulting in right temporal/occipital and left occipital infarcts. Urgent neurosurgical intervention is required.
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