Chronic epidural hematoma presenting with diplopia

Area of Science:

• Neurosurgery
• Neurology
• Trauma Surgery

Background:

• Epidural hematomas are common after traumatic brain injuries, often linked to skull fractures.
• While many require immediate surgery, some present chronically with subtle symptoms like diplopia.
• Conservative management or delayed surgical intervention may be considered based on stability and mass effect.

Observation:

• A 32-year-old man presented with diplopia six weeks post-head trauma.
• Imaging revealed a chronic epidural hematoma.
• Intraoperative findings included thick, inflammatory tissue overlying the dura.

Findings:

• Surgical resection of the chronic epidural hematoma and associated fibrous tissue was performed.
• The patient experienced near-complete resolution of diplopia and complete hematoma resolution six weeks post-surgery.
• Complete resection of the inflammatory tissue was deemed necessary for brain parenchyma reexpansion.

Implications:

• This case highlights the importance of considering chronic epidural hematomas in delayed post-traumatic presentations.
• Complete removal of inflammatory membranes may be essential for optimal clinical outcomes in chronic epidural hematomas.
• Effective surgical management can lead to significant neurological recovery.