A 5-year-old male suffered a head injury after falling from a height of 2 meters. Upon admission, five hours after the accident, he had a Glasgow Coma Scale (GCS) of 15. Brain computed tomography (CT) revealed an epidural hematoma (EDH) in the right temporoparietal area and a subdural hematoma (SDH) in the left temporal area (), as well as a skull fracture in both temporal bones. Emergency right craniotomy was performed and the EDH was evacuated. The underlying dura was loose and depressed. Intraoperative TCS applied to the right craniectomy site revealed no expansion of the left side hematoma (). The damaged meningeal artery was coagulated, dural tacking sutures were placed to prevent EDH re-accumulation, and the bone flap was repositioned.\nAfter confirming no change in the contralateral hematoma volume by postoperative brain CT immediately after surgery, the patient was admitted to the intensive care unit. After arousal, his GCS score had not changed. The patient was discharged on hospital day 13 with no definite neurological deficit.
A 30-year-old male, was admitted 1.5 hrs following trauma, with a GCS score of 7/15 and asymmetric but reacting pupils. A CT scan of the brain showed an acute SDH in the right fronto-temporo-parietal region with mass effect and midline shift []. There was also a thin EDH and a speck of extradural air in the contralateral temporal region, underlying an undisplaced fracture of the parietal bone, and diastasis of the squamosal suture [Figure and ]. He underwent emergency surgical evacuation of the SDH. A lax duroplasty, was performed, and the bone flap was not replaced, as the brain was tense. He remained under ventilator support, with the pupils equal and reacting to light. An hour later, his left pupil became dilated and nonreacting. A CT scan of the brain showed a large contralateral EDH and a thin SDH with midline shift, subfalcine, and uncal herniation []. The EDH showed mixed densities and “swirl sign” suggesting active hemorrhage. He underwent an emergency craniotomy, evacuation of the left EDH, and bipolar coagulation of the actively bleeding posterior branch of the middle meningeal artery (MMA). The dura was not opened, as the SDH was thin and the dura was lax after the evacuation of the EDH. Postoperatively, the pupils were again equal and reacting to light. A follow-up CT scan of the brain showed no residual EDH and a thin acute SDH []. His GOS-E was 7 (lower good recovery), at 6 months.