Brain herniation caused by acute progressive epidural hematoma in plateau area:a case report

SANG Bu; DAN Zeng; SANG Jie; ZUNZHU Qu-zong; QI Hong-wu

doi:10.13798/j.issn.1009-153X.2024.02.014

Abstract：Acute epidural hematoma(AEDH)is a type of hematoma that develops in the potential space between the dura mater and the inner plate of the skull within 3 days following cranial trauma.Some cases of AEDH are progressive,with initial symptoms being mild or obscured by contusion symptoms;the first head CT scan may not detect the epidural hematoma or it may be small,but upon reexamination after some time,the hematoma may become apparent or increase in size.In severe cases,brain herniation may occur,posing a life-threatening risk to the patient.This paper reported a case of AEDH in a plateau area involving a 50-year-old male who presented to the hospital 0.5 hours after falling from a height with headaches,dizziness,nausea,and vomiting.The patient had a GCS score of 14 on admission.The initial head CT scan showed linear high-density in the left fissure area,gas shadow below the left temporal-occipital skull plate,along with a small amount of epidural hematoma,and curved high-density below right temporal base dura.Six hours after admission,the patient's condition deteriorated with GCS score dropping to 7 and dilated left pupil up to 5 mm with loss of light reflex.A repeat head CT revealed formation of large epidural hematoma in left temporal-occipital region,significant midline shift,and deformation of left lateral ventricle.An emergency craniotomy for hematoma evacuation was performed under general anesthesia.Postoperative CT scan 2 hours after surgery showed complete clearance of left temporal-occipital epidural hematoma.At six-month follow-up visit,the patient had a GOS score of 5.This suggests that patients with traumatic brain injury should undergo decompression and hematoma evacuation as soon as possible when the patients have the indication of surgery.