Contralateral epidural hematoma after decompressive surgery: Case report and systematic literature review

INTRODUCTION: and importance: Contralateral epidural hematoma (EDH) after decompressive surgery for acute subdural hematoma (ASDH) is uncommon. If unrecognized, this delayed hematoma can lead to devastating consequences. CASE PRESENTATION: A 30-year-old patient with no past medical history, was brought to the emergency after a severe brain injury secondary to an aggression, Glasgow coma scale was 6 (E1V1 M4) with a left anisocoria. The CT scan revealed a left acute subdural hematoma with midline shift superior than 10 mm, and a non-surgical contralateral EDH was also identified. The patient was operated on urgently. Post-operatively, the pupils became equal sized and reactive. A right anisocoria was noticed 12 h later, with a large contralateral EDH on CT scan associated to a gross midline shift. A second operation was performed immediately with a good recovery and the patient was extubated one week post-operatively. CLINICAL DISCUSSION: The most common surgical complications after a decompressive craniectomy for an acute subdural hematoma noted in literature are surgical site herniation, post-operative infections, epilepsy, and subdural effusions with or without hydrocephalus. Contralateral epidural hematoma (EDH) after decompressive craniectomy is also documented (Ban et al., 2010; Nadig and King, 2012) [3,15], however it's rare with only 100 cases, including the present one reported. CONCLUSIONS: Delayed contralateral EDH after decompressive surgery should be anticipated in the presence of contralateral skull fracture and/or intraoperative brain swelling and immediate postoperative scan is indicated. Early detection of this fatal complication and prompt treatment may improve the poor outcome in this group of patients.