PMC9990800_01
Head computed tomography on admission. (a) Traumatic subarachnoid hemorrhage and a 1-cm thick vertex epidural hematoma overlying the superior sagittal sinus. (b and c) Parietal skull fracture reaching a diastatic fracture of the sagittal suture.
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F1
Computed tomography (CT) showed traumatic subarachnoid hemorrhage, a 1-cm thick VEDH overlying the SSS, and a parietal skull fracture reaching a diastatic fracture of the sagittal suture [Figure 1].
Coronal (a, c) and sagittal (b, d) head computed tomography. (a and b) Hematoma overlying the superior sagittal sinus at arrival. (c and d) The hematoma increased 1 h later.
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F2
Head CT 1 h (hour) later showed increased hematoma, but there was no enlargement another hour later and the patient had no exacerbation of neurological symptoms [Figures 2].
Time course of coagulation and fibrinolytic parameters. D-dimer increased progressively between admission and 3 h after injury and decreased after 3 h. Plasma fibrinogen decreased between admission and 3 h after injury but was maintained at >200 mg/dL.
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F3
Six units of fresh frozen plasma (FFP) were administered and fibrinogen concentration at 3 and 6 h after injury was maintained at >150 mg/dL [Figure 3]. The plasma fibrinogen concentration was within the normal postoperative range [Figure 3].
Illustration of the operative view. A horseshoe skin incision overlying the lesion was sketched. Burr holes were placed on each side and parasagittal craniotomy was performed, leaving a midline island of bone including the peritoneal fracture and diastatic fracture.
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F4
A horseshoe skin incision overlying the lesion was sketched [Figure 4].
Coronal (a) and sagittal (b) head computed tomography. Postoperatively, there was no residual hematoma, no recurrence of contusion, and decompression of brain tissue.
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F5
Postoperative head CT showed no residual hematoma and no recurrence of hemorrhage and contusion [Figure 5].