Acta Neurologica Belgica

, Volume 119, Issue 1, pp 15–20 | Cite as

Development of a delayed acute epidural hematoma following contralateral epidural hematoma evacuation: case report and review of literature

  • Fabrizio GregoriEmail author
  • Giorgio Santoro
  • Cristina Mancarella
  • Manolo Piccirilli
  • Maurizio Domenicucci
Review Article


The formation of a post-traumatic delayed epidural hematoma (DEDH) is a rare but well-described complication in the literature. It is defined as an extradural bleeding not evident at the first computed tomography (CT) scan performed after trauma, but evidenced by further radiological evaluations. The most supported hypothesis about the mechanism responsible for the formation of a DEDH concerns above all the loss of a tamponade effect given by the reduction of intracranial pressure with medical or surgical treatment. A 30-year-old man was admitted to the emergency department with an epidural hematoma (EDH) associated with a linear calvarial bitemporal coronal fracture. A few hours after the surgical procedure for hematoma evacuation, the patient developed a DEDH contralateral to the site of surgical procedure. The literature review identified other 27 analogue cases. The presence of a calvarial fracture contralateral to the site of a craniotomy and the intraoperative brain swelling during EDH removal are suspicious for the development of DEDH. A CT scan has to be urgently performed in this situation. The timing of postoperative radiological examinations after EDH removal has to consider possible complications and has to be balanced on the basis of patient’s clinical condition and neuroradiological data, such as skull fractures or intraoperative anomalies. The development of a DEDH after the surgical removal of an EDH is a rare event, characterized by a high mortality rate. DEDH develops preferentially on the contralateral side and with a concomitant skull fracture.


Epidural hematoma Delayed epidural hematoma Traumatic brain injury Skull fracture Head injury 



Delayed epidural hematoma


Epidural hematoma


Computed tomography


Intracranial pressure



This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

All the authors have no conflict of interest to declare.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

For this type of study formal consent is not required.


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Copyright information

© Belgian Neurological Society 2018

Authors and Affiliations

  1. 1.Division of Neurosurgery, Department of Human NeurosciencesSapienza University of RomeRomeItaly
  2. 2.NeurosurgeryIRCCS NeuromedPozzilliItaly

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