title: Remote postoperative epidural hematoma after subdural hygroma drainage.
abstract: Objective. Subdural hygroma is reported to occur in 5%-20% of all patients with closed head trauma, the treatment is controversial and in symptomatic cases surgical drainage is need. We report on a new case with remote acute epidural hematoma (AEH) after subdural hygroma drainage. Case Presentation. A 38-year-old man suffered blunt head trauma and had diffuse axonal injury grade III in CT scan. A CT scan that was late performed showed an increasing subdural fluid collection with mild mass effect and some effacement of the left lateral ventricle. We perform a trepanation with drainage of a hypertensive subdural collection with citrine aspect. Postoperative tomography demonstrated a large left AEH. Craniotomy and evacuation of the hematoma were performed. Conclusion. The mechanism of remote postoperative AEH formation is unclear. Complete reliance on neurologic monitoring, trust in an early CT scan, and a relative complacency after an apparently successful initial surgery for hygroma drainage may delay the diagnosis of this postoperative AEH.
authors.affiliation: Division of Neurosurgery, University of São Paulo, 01416001, Brazil.
authors.forename: Wellingson Silva
authors.initials: WS
authors.lastname: Paiva
authors.forename: Arthur Maynart Pereira
authors.initials: AM
authors.lastname: Oliveira
authors.forename: Almir Ferreira
authors.initials: AF
authors.lastname: de Andrade
authors.forename: Roger Schmidt
authors.initials: RS
authors.lastname: Brock
authors.forename: Manoel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira