Delayed onset of traumatic extradural hematoma.

Area of Science:

• Neurosurgery
• Trauma Medicine
• Radiology

Background:

• Extradural hematomas are a significant concern in traumatic brain injury.
• Delayed onset of extradural hematomas presents a diagnostic challenge.

Observation:

• Seven cases (8.75%) of delayed extradural hematoma were identified over 4.5 years.
• Initial CT scans showed minimal or no hemorrhage; repeat scans revealed significant bleeds.
• Neurological status varied, with most patients stable or improving before diagnosis.

Findings:

• Intracranial pressure monitoring revealed intermittent rises in four patients.
• Intracranial hypotension and recovery from shock were identified as potential contributing factors.
• Six hematomas required surgical evacuation; one resolved spontaneously.

Implications:

• Early recognition of delayed extradural hematoma is vital.
• Recommend high vigilance, intracranial pressure monitoring, and repeat CT scans within 24 hours.
• Consider this entity in patients with skull fractures, post-decompression, or recovery from shock.