Bilateral intracraneal epidural hematoma : A Dilemma ?

C. Martorell-Llobregat; I.Verdú Martinez; J.Sales-Llopis

Neurosurgery Service, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL - FISABIO Foundation), Alicante, Spain.

Bilateral intracranial acute epidural hematoma reports have been sporadic with an incidence rangs from 0,5 to 2% of all intracranial acute epidural hematomas ^{1) 2) 3)}. The first bilateral intracranial acute epidural hematoma case was described by Roy in 1884 ⁴⁾. In cases of bilateral hematomas, EDH is most common ^{5) 6)}.

Dharker et al. ⁷⁾ found a very high incidence of up to 20% in the pediatric age group. The ratio of Görgülü et al. in the same group was 5.2% ⁸⁾. It is suggested that two types of bilateral extradural hematoma may be found, depending upon whether venous or arterial bleeding is responsible ⁹⁾.

This 31 year-old woman had a history of fell from a 3rd floor through the stairs. Emergency services found the patient with Glasgow Coma Scale 4 points with dilated pupils reactive to light, but lazy. Patient was intubated and brought to our hospital. A CT scan was performed (see fig 1) and a billateral epidural hematoma was found with signs of brainstem compression.

Fig 1

Surgical evacuation of the clot was performed by two craniotomies. Postoperative CT scan showed complete resolution of the bleeding with no complications. ICP monitoring revealed normal pressure during her stay in ICU.

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