Acute Epidural Hematoma Caused by Contrecoup Head Injury-Case Report-

Abstract

A 50-year-old woman presented with a rare case of contrecoup epidural hematoma (EDH) associated with coup EDH. She was hit by a car while riding a bicycle, and struck the left parietal region of her head on the ground. She was dazed for a few minutes. On admission, she complained of nausea but exhibited no neurological deficits. Skull radiography revealed a linear fracture of the left temporal bone. Computed tomography (CT) demonstrated acute EDH in the right frontal region due to contrecoup injury, and thin EDH in the left temporal region due to coup injury. She vomited repeatedly after admission. She became lethargic and exhibited right hemiparesis. CT, taken 2 hours later, revealed enlargement of the left coup EDH, but no enlargement of the right contrecoup EDH. An emergent evacuation of the enlarged coup EDH was performed. Immediately after the operation, she became alert and the right hemiparesis subsided. The contrecoup EDH was conservatively treated, in the absence of enlargement. She was discharged 12 days after the injury without neurological deficits.

Traumatic Coronal Suture Diastasis and Contre-Coup Epidural Hematoma

“…Only two other cases satisfied these criteria and they are summarized in the Table with our case for comparison, 12,13 with two further cases involving isolated contrecoup posterior fossa epidural hematoma after forehead impact. 14,15 Conversely, there are several other cases in association with association with coup epidural hematoma 16,17 , subdural hematoma 18 , or contusion 19,20 . In the two previously reported cases, no clear mechanism was found to underlie the development of these lesions.…”

An atypical case of head trauma with late onset of contrecoup epidural hematoma, cerebellar contusion, and cerebral infarction in the territory of the recurrent artery of Heubner

“…[26][27][28][29][30][31] Nakamura reported that the negative pressure in the forehead caused by head injury in the occipital region was 1.6 times the occipital positive pressure, and that the dura of the frontal lobe was susceptible to dissection. 42 The dura mater of the lateral frontal lesion is easily detached from the inner table.…”

“…42 The dura mater of the lateral frontal lesion is easily detached from the inner table. [26][27][28][29][30][31] These anatomical mechanisms, together with coagulopathy, may have caused the contrecoup epidural hematoma in the present case.…”

“…5,26-31 Only 7 cases have been reported. 5,[26][27][28][29][30][31] Four of the 7 patients underwent craniotomy for the contrecoup epidural hematoma. One patient died of posterior fossa contusion and hematoma despite having undergone an operation for coup injury.…”

Contrecoup epidural hematoma

“…The interesting features of patients with contrecoup EDH included: Female predominance, relatively old mean age, high frequency of frontal region involvement, and high rates of delayed appearance of EDH. [9] Delayed EDH is considered uncommon, with a reported incidence of approximately 3%. The peak incidence of EDH is in the second decade, with a mean age of 20-30 years; EDH is rare in patients older than 50-60 years.…”