Eftekhar Behzad, Ketabchi Ebrahim, Ghodsi Mohammad, Esmaeeli Babak
Department of Neurosurgery, Sina Hospital, Tehran University, Tehran, IRAN.
BMC Emerg Med. 2003 Dec 30;3(1):1. doi: 10.1186/1471-227X-3-1.
Bilateral extradural hematomas have only rarely been reported in the literature. Even rarer are cases where the hematomas develop sequentially, one after removal of the other. Among 187 cases of operated epidural hematomas during past 4 years in our hospital, we found one case of sequentially developed bilateral epidural hematoma. CASE PRESENTATION: An 18-year-old conscious male worker was admitted to our hospital after a fall. After deterioration of his consciousness, an emergency brain CT scan showed a right temporoparietal epidural hematoma. The hematoma was evacuated, but the patient did not improve afterwards. Another CT scan showed contralateral epidural hematoma and the patient was reoperated. Postoperatively, the patient recovered completely. CONCLUSIONS: This case underlines the need for monitoring after an operation for an epidural hematoma and the need for repeat brain CT scans if the patient does not recover quickly after removal of the hematoma, especially if the first CT scan has been done less than 6 hours after the trauma. Intraoperative brain swelling can be considered as a clue for the development of contralateral hematoma.
双侧硬膜外血肿在文献中报道极少。血肿依次发生，即一个血肿清除后另一个出现的情况更为罕见。在我院过去4年的187例硬膜外血肿手术病例中，我们发现了1例依次发生的双侧硬膜外血肿。病例介绍：一名18岁神志清醒的男性工人跌倒后被送入我院。意识恶化后，急诊脑部CT扫描显示右侧颞顶部硬膜外血肿。血肿被清除，但患者术后未改善。另一次CT扫描显示对侧硬膜外血肿，患者再次接受手术。术后，患者完全康复。结论：该病例强调了硬膜外血肿手术后进行监测的必要性，以及如果患者在血肿清除后未迅速康复，尤其是在创伤后6小时内首次进行CT扫描的情况下，需要重复进行脑部CT扫描。术中脑肿胀可被视为对侧血肿发生的一个线索。
