Case report of severe head injury with bilateral intracranial hematomas: Multidisciplinary treatment results in good outcome

Abstract

A female bicyclist in her 30s was struck by a car and immediately examined by a physician at that location, who found no airway, breathing, or circulation problems. Glasgow coma scale was 7 points, with left-sided incomplete paresis. Transportation to our medical center was done under respiratory ventilation with intubation. Whole body computed tomography (CT) indicated multiple traumas, including right contrecoup subdural hematoma. Burr-hole surgery was performed for elevated intracranial pressure (ICP) (43 mmHg). Follow-up CT findings revealed left coup epidural hematoma at the temporal bone fracture, thus left craniectomy and decompression procedures were done. No right contrecoup subdural hematoma expansion was revealed by CT, and intensive care was started 8 hours 40 minutes after admission. The respirator weaned, with extubation on day 12. Cranioplasty was performed on day 35 and hospital release was day 45. Left decompressive craniectomy for coup epidural hematoma and intensive care were effective for ICP control, with no need for a right craniectomy.