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.
A 51-year-old female was admitted with a head injury after a pedestrian accident. Upon admission, one hour after the accident, she had a GCS of 14. Brain CT revealed an EDH in the right temporoparietal area, SDH in the left frontal area (), and skull fracture in the right temporal and left frontal bone. Emergency right craniotomy was performed and the EDH was evacuated. Softened dura matter was found after performing craniectomy. Intraoperative TCS applied to the craniectomy site revealed volume expansion of the EDH in the left frontal area (). The bone flap was repositioned. Her vital signs were stable, and she was transported to the CT room. Brain CT confirmed the presence of a de novo EDH in the left frontal area. As a result, a second operation was performed on the left side. Her postoperative GCS score was 14, and the patient was discharged on hospital day 20 with no definite neurological deficit.