PMC6417312_01
(a) The fracture in the temporal bone, (b) the epidural hematoma, and (c) the absence of epidural hematoma along with a corresponding increase in the epicranial hematoma
AJNS-14-292-g001.jpg
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F1
Initially, he was taken to a local hospital where computed tomography of the head was done which revealed an extra-axial hyperdense collection of hemorrhagic attenuation with few air pockets within and along the right parietal and anterior temporal convexity with mass effect in the form of compression of right lateral ventricle and minimal midline shift to left [Figures 1b and 2] along with fracture of right parietal bone extending up to squamous and mastoid parts of right temporal bone [Figure 1a]. The patient was intubated and a computed tomography of the brain was repeated which, to our astonishment, revealed no epidural hematoma but showed hemorrhage along the falx, and the same fracture details described above and an increased epicranial soft-tissue thickening were also noted [Figures 1c and 3].
The initial scan was done at a rural center where no neurosurgeon was available, showing a large epidural hematoma approximately 60 ml in volume
AJNS-14-292-g002.jpg
PMC6417312_01_AJNS-14-292-g002.jpg
F2
Initially, he was taken to a local hospital where computed tomography of the head was done which revealed an extra-axial hyperdense collection of hemorrhagic attenuation with few air pockets within and along the right parietal and anterior temporal convexity with mass effect in the form of compression of right lateral ventricle and minimal midline shift to left [Figures 1b and 2] along with fracture of right parietal bone extending up to squamous and mastoid parts of right temporal bone [Figure 1a].
The second scan done at our tertiary care center, showing the resolution of epidural hematoma
AJNS-14-292-g003.jpg
PMC6417312_01_AJNS-14-292-g003.jpg
F3
The patient was intubated and a computed tomography of the brain was repeated which, to our astonishment, revealed no epidural hematoma but showed hemorrhage along the falx, and the same fracture details described above and an increased epicranial soft-tissue thickening were also noted [Figures 1c and 3].