Delayed presentation of an epidural hematoma

The formation of delayed intracranial hematomas should be considered in a head-injured patient who experiences clinical deterioration, especially after surgical evacuation of an initial hematoma or placement of an ICP monitor. Development of increased ICP or neurological deterioration following the administration of mannitol should also raise suspicion of new lesions. Immediate follow-up CT should be performed for declining neurological status. Repeat CT is recommended within 24 hours of admission or within 24 hours after craniotomy, even if the patientʹs neurological status has not deteriorated. New mass effects are often seen in patients who deteriorate neurologically after head injury.