Traumatic extradural haematoma revealed after contralateral decompressive craniectomy.

Traumatic extradural haematoma following a severe head injury is well documented in neurosurgical literature. We report a case of traumatic extradural haematoma which initially was concealed by the high intracranial pressure (ICP) and revealed after the contralateral decompressive craniectomy. A 21-year-old roofer sustained severe head injury from a fall. The CT brain showed right sided fronto-temporal contusions with small acute subdural haematoma and left orbital roof fracture extending into the temporal bone. ICP was above 45 mmHg even after maximal medical therapy. Decompressive craniectomy was performed on the right side along with contusionectomy. Within an hour, ICP spiked and the CT brain showed left side extradural haematoma. The second surgery demonstrated a bleeding middle meningeal artery associated with the left temporal bone fracture. The clinical sequence of events, radiological and operative findings revealed this to be a traumatic extradural haematoma sustained at the initial trauma. This was revealed after the tamponade effect was released from the initial decompressive craniectomy on the contralateral side.