抄録
The authors reported a case of acute epidural hematoma which developed four hours after irrigation of the chronic subdural hematoma.
A 56-year-old man was admitted. He was drowsy and disorientated with a one-month history of headache and dysarthria, but no other neurological deficits were noted. Laboratory data including bleeding and coagulating time, were all within the normal ranges. CT scanning and left carotid angiography showed a large left subdural hematoma. Irrigation of the subdural hematoma was performed the next day through two burr holes in the left fronto-parietal region under local anesthesia. About 150 ml of subdural hematoma was removed. Four hours after irrigation, he was semicomatose with right hemiplegia. CT scanning was immediately performed and reveled a epidural hematoma in the left parieto-occipital region. About 120 g of epidural hematoma was removed by left parieto-occipital craniotomy nine hours after the first operation. He gradually improved, and was discharged ambulant on the 51st postoperative day.
The presumptive pathogenesis responsible for the development of the epidural hematoma in this case was bleeding from small dural vessels after detachment of the dura from the skull in the left parieto-occipital region. It was considered that the detachment occurred at the posterior burr hole in the beginning and was then accelerated by postoperative intensive evacuation of the hematoma through a closed-system drain.
