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 39-year-old White Brazilian man was admitted to our Emergency Department after a motorcycle accident on a highway. Although he was hemodynamically stable, a neurological assessment revealed a Glasgow Coma Scale (GCS) of six points and right eye mydriasis. No clotting dysfunction was detected by laboratory test. Computed tomography (CT) of his brain revealed right side ASDH, hemispheric edema and midline shift of 15.7mm with compression of his right lateral ventricle (Figure \n). He was immediately transferred to the Operating Room and a right decompressive craniectomy was performed. He was kept under sedation and his intracranial pressure (ICP) was continuously monitored in the intensive care unit. On the first postoperative day, he started to present elevated ICP refractory to hyperventilation and osmotic therapy. A new CT was then obtained and showed a large contralateral EDH (Figure \n) and frontal hemorrhage associated with catheter insertion. He was taken again to the Operating Room and surgical evacuation of the hematoma was performed. A brain CT following the second operation, revealed no residual EDH (Figure \n). He evolved hemodynamically unstable within the first 48 hours and no neurological improvement was observed after weaning sedation. He died on the ninth postoperative day.