Delayed traumatic interacranial haematoma in postoperative patients: a case for serial computerised tomography

ABSTRACT

Delayed traumatic intracranial haematoma [DTIH] is an uncommon entity and an epiphenomenon of head injury. Its time of evolution and location is unpredictable. We report two cases of DTIH. First patient was a road traffic accident victim who had left fronto-temporal acute subdural haemoatoma [SDH] with brainstem haemorrhage. Following evacuation of acute SDH, his intracranial pressure [ICP] remained high and repeat computerised tomography [CT] scan of the head done 36 hours later, revealed a large right parieto-temporal acute extradural haematoma [EDH]. The second patient had a minor head injury, 2 weeks prior to admission and CT scan of the head revealed an isodense right fronto-parietal chronic SDH. Eleven days following evacuation of chronic SDH, he developed headache and altered sensorium and repeat CT scan of the head showed right medial temporal intracerebral haematoma [ICH]. Evolution of second intracranial haematoma changes the total clinical scenario. Their clinical manifestation, especially in a postoperative patient is delayed and the prognosis adversely affected by the delay in treatment. Early detection of such haematoma is crucial. Combination of close clinical surveillance, ICP monitoring and radiological evaluation is suggested, however there are limitations and inherent fallacies. Mechanism of evolution and strategies for early detection of DTIH in a postoperative situation is discussed