Delayed post-traumatic extracerebral hematomas

Acute craniocerebral trauma remains a difficult management problems. Optimal conditions for recovery require stabilization of vital signs, removal of a mass lesion when present, and control of intracranial pressure. While computerized tomography (CT) has helped achieve these objectives, there remain patients who may develop a second extracerebral hematoma not evident on their initial preoperative scan. This report concerns our experience with patients who developed such delayed post-traumatic extracerebral hematomas shortly after evacuation of hematomas at other sites. Between 1 January 1979 and 1 October 1980, 47 patients underwent emergency evacuation of a traumatic extracerebral hematoma (38 acute subdural and 18 acute epidural hematomas) at the Yale New Haven Hospital. Within 24 hours, four patients developed, in addition, a total of six delayed extracerebral hematomas (10%) which also required evacuation. In all of these patients a skull fracture was present at the site of the delayed hematomas. This experience suggests: 1) Exploration of extracerebral space beneath a skull fracture should be considered following evacuation of a hematoma at another site. 2) Repeat CT is indicated if anticipated improvement does not occur after evacuation of a hematoma. 3) Decompression of the intracranial contents by removal of a hematoma may promote the development of another delayed hematoma.