A case of severe head injury with repeated contralateral hematomas in a young patient — Study of surgical strategy

Abstract

  We report the case of a 14‒year‒old girl with severe head injury with bilateral intracranial hematomas that occurred repeatedly. Emergency surgery was performed, leading to a favorable outcome. The patient was riding on a motorcycle when she crashed with a car and suffered head injuries. Her consciousness level on arrival was GCS 6, and dilation of the right pupil was noted. During primary care, left hemopneumothorax was observed, and thoracic drainage was performed. Initial computed tomography (CT) of the head revealed right acute subdural hematoma (ASDH) and linear fracture of the left temporal bone. In the emergency room (ER) of the critical care center, craniotomy was performed to remove the right ASDH. Dilation of the left pupil was noted immediately after surgery, and CT revealed left acute epidural hematoma (AEDH), which was then removed in the ER by craniectomy. The patient was transferred to the operating room, and left craniotomy was conducted. Immediately after surgery, dilation of the right pupil was observed, and additional right craniotomy was performed. A third CT scan showed brain contusion in the right frontal lobe, and internal decompression was carried out. The patient’s postoperative course was favorable and after 8 months, she was referred to another hospital for rehabilitation. However, assessment using the Glasgow Outcome Scale (GOS) upon discharge from our hospital suggested moderate disability (MD). Early decompression in the ER and surgery for contralateral hematoma detected on postoperative CT may have led to a more favorable outcome.