Multiple Ipsilateral Acute Epidural Hematomas: A Case Report and Literature Review

Acute epidural hematoma (AEDH) typically develops from a skull fracture caused by head injuries and usually presents as a single lesion. The surgical strategy becomes more complex when multiple AEDHs are present. In this report, we present the usefulness of CT angiography for detecting active bleeding lesions in multiple AEDHs. A 33-year-old man was transferred to our hospital with a head injury. Two isolated right-sided AEDHs were observed on CT: a thick temporoparietal lesion causing a midline shift and another thin lesion in the middle cranial fossa. Contrast-enhanced CT revealed extravasation in both hematoma cavities, and CT angiography revealed pseudoaneurysms along with the middle meningeal artery at both AEDHs. The patient underwent simultaneous evacuation of both hematomas. Active bleeding was observed at the pseudoaneurysm lesions identified on the CT angiography, and the bleeding arteries had coagulated. The patient recovered without any neurological deficit. Our case clearly showed that contrast-enhanced CT and CT angiography were valuable for visualizing the active bleeding associated with AEDHs.