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Spontaneous disappearance of an acute epidural hematoma with emergence of a contralateral subdural hematoma after traumatic brain injury

Sheng-Wen Wu, Tsung-Lang Chiu, Shin-Yuan Chen, Chain-Fa Su, Sheng-Tzung Tsai

Department of Neurosurgery, Institute of Neuro-Medical Science Center, Buddhist Tzu Chi General Hospital, Hualien, Taiwan

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Abstract
Epidural hematoma (EDH) is a common sequela of traumatic brain injury (TBI) and usually results in life-threatening brain compression, which warrants emergency surgical evacuation. Here we present an 85-year-old man who had a traumatic brain injury with an EDH in the right frontoparietal area. He was transferred to our hospital with deep coma status and follow-up computed tomography (CT) showed the EDH had spontaneously disappeared within 2 hours. Furthermore, a contralateral subdural hematoma had developed, which caused a midline shift. Rare cases of rapid spontaneous resolution of an EDH have been reported in the literature. In our patient, the EDH seemed to have been pushed out from the fractured skull because the hematoma would not coagulate due to an underlying coagulopathy. Repeat CT is imperative before surgery for acute TBI and for unconscious patients whose initial CT was performed within 3 hours of injury.

Keywords
Computed tomography; Epidural hematoma; Traumatic brain injury


 

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