Delayed Post-traumatic Extradural Hematomas: Delayed Bleeding & Delayed Expansion

Delayed traumatic extradural hematoma is a new pathological dimension. Thirteen patients with delayed traumatic extradural hematoma were seen 70 treated cases of extradural hematomas for a frequency of 18.6%. The hematomas were insignificant or not present on the initial CT scanning. All patients had a skull fracture at the site of delayed extradural hematoma formation. Ten hematomas were surgically evacuated and three were reabsorbed spontaneously. Repeated CT scanning was performed if the patient has any new focal neurological deficits or clinical status was not improved despite of minimal extradural hematoma after head injury. Delayed extradural hematoma were classified into two groups based on the presence of hematoma in initial CT scan : delayed bleeding type(newly formed xtradural hematoma/4 cases : 5.7%) & delayed expansion type(enlargement of initial thin hematoma/9 cases : 12.6%).

Delayed Epidural Hematoma

Four cases of delayed post-traumatic epidural hematoma which had not been present on initial CT scan were found on repeated CT scan. The delayed epidural hematoma was developed after evacuation of a hematoma in all cases. And a skull fracture was present at the site of the delayed hematoma in two cases. The neurologic deterioration heralded the onset of delayed epidural hematoma after decompressive therapy by either surgical or medical means. Repeated CT scan is indicated if anticapated improvement from does not occur after decompression by either surgical or medical means, recovery from shock, or whenever there is evidence of even minimal bleeding under a skull fracture on the initial CT scan.