Rapid diagnosis and treatment of contralateral epidural hematoma following decompressive craniotomy

Contralateral epidural hematomas following rapid evacuation of acute subdural hematomas is not a rare situation, however, only a few cases have been reported. In previous reported cases, patients usually were found when a CT study was made for an unexpected poor recovery or dilated pupils. The delay in early diagnosis resulted in a poor recovery of patients or a not operable condition because they were moribund. The authors will present their experiences with 10 cases in early diagnosis and rapid management of contralateral epidural hemorrhages after rapid removal of subdural hematomas. Prompt recognition of contralateral bleeding is the key for a favorable outcome. In our cases, epidural bleeding usually occurred in the area of the fractured skull. Acute brain swelling in a relatively “soft” brain during evacuation of subdural hematoma should alert immediately to a possible contralateral hematoma. Because of the time involved in closure the wound of craniotomy and in obtaining CT studies, the evacuation of contralateral epidural hematoma will be delayed. To avoid such delays, the authors performed burr-hole exploration on the contralateral side or intra-operative CT scanning before closure the wound of craniotomy. All these 10 patients had positive findings, underwent rapid one-procedure contralateral craniotomies, and had a rapid recovery. Our results indicated that rapid decompressive procedure is essential for a successful outcome, exploratory burr holes in the fractured area when suspecting a contralateral lesion is a better strategy than awaiting a postoperative CT scan.