Traumatic Posterior Fossa Acute Epidural Hematoma with Frontal Hemorrhagic Contusion in a 25-Year-Old Male: Immediate Craniotomy and Successful Recovery

Traumatic posterior fossa extradural hematoma (PFEDH) is a rare but potentially life-threatening condition. It is characterized by the accumulation of blood between the dura mater and occipital bone, leading to compression of the brainstem. We report the case of a 25-year-old male who presented to the emergency department following a fall, exhibiting confusion and a Glasgow Coma Scale (GCS) score of 14. Imaging revealed a significant acute epidural hematoma with associated mass effect, frontal hemorrhagic contusion, and right transverse sinus rupture. The initial hematoma volume was calculated to be 44.41 cm3 using the ellipsoid formula. Prompt neurosurgical intervention was performed, including craniotomy for hematoma evacuation and suction tube placement. Despite a decline in GCS score postoperatively, subsequent surgical management led to hematoma resolution and neurological improvement. The hematoma volume had decreased to 33.19 cm3 after the second intervention. After 15 days, the patient achieved a GCS score of 15. Our case highlights the importance of early recognition, emergent surgical intervention, and standardized management protocols for the treatment of PFEDH. In addition, it emphasizes the value of quantitative hematoma measurements in guiding treatment decisions. Prompt diagnosis and treatment are crucial to alleviate the potentially fatal consequences of this rare neurological condition.