title: Bilateral assymetric epidural hematoma.
abstract: BACKGROUND
  Acute bilateral extradural hematoma is a rare presentation of head trauma injury. In sporadic cases, they represent 0.5-10% of all extradural hematomas. However, higher mortality rates have been reported in previous series.
  
  
  METHODS
  The authors described the case of a 28-year-old male presenting head injury, comatose, Glasgow Coma Scale of 6, anisocoric pupils without puppilary light reflex. Computed tomography showed asymmetric bilateral epidural hematomas, effacement of the lateral ventricles and sulci, midline shift and a bilateral skull fracture reaching the vertex. Surgical evacuation was performed with simultaneous hematoma drainage. Patient was discharged on the 29(th) postoperative day with no neurological deficit.
  
  
  CONCLUSIONS
  The correct approach on bilateral epidural hematomas depends on the volume, moment of diagnosis, and neurological deficit level. Simultaneous drainage of bilateral hematomas has been demonstrated to be an effective technique for it, which soon decreases the intracranial pressure and promotes an efficient resolution to the neurological damage.
authors: Neurosurgeon, Department of Neurological Surgery, Metropolitan Hospital of Urgencies and Emergencies, Belém, PA, Brazil.
authors: Edmundo Luis Rodrigues
authors: EL
authors: Pereira
authors: Department of Neurosurgery, School of Medicine, State University of Para, Belém, PA, Brazil.
authors: Daniella Brito
authors: DB
authors: Rodrigues
authors: Neurosurgeon, Department of Neurological Surgery, Metropolitan Hospital of Urgencies and Emergencies, Belém, PA, Brazil.
authors: Lorena Oliveira
authors: LO
authors: Lima
authors: Neurosurgeon, Department of Neurological Surgery, Metropolitan Hospital of Urgencies and Emergencies, Belém, PA, Brazil.
authors: Luis Armando
authors: LA
authors: Sawada
authors: Neurosurgeon, Department of Neurological Surgery, Metropolitan Hospital of Urgencies and Emergencies, Belém, PA, Brazil.
authors: Mário de Nazareth
authors: Mde N
authors: Hermes
keywords: Bilateral; extradural; hematoma; trauma; traumatic brain injury
references: J Neurosurg. 1977 Oct;47(4):491-502
references: 903803
references: No Shinkei Geka. 2004 Apr;32(4):379-82
references: 15227846
references: Neurocirugia (Astur). 2005 Jun;16(3):256-60
references: 16007324
references: Neurochirurgia (Stuttg). 1987 Nov;30(6):193-6
references: 3696357
references: Surg Neurol. 1988 Nov;30(5):339-41
references: 3055383
references: BMC Emerg Med. 2003 Dec 30;3(1):1
references: 14697100
references: Surg Neurol. 2003 Jul;60(1):23-30; discussion 30
references: 12865006
references: Neurosurgery. 1988 Jul;23 (1):44-51
references: 3173664
references: Niger J Clin Pract. 2012 Jan-Mar;15(1):104-7
references: 22437103
references: Neurosurg Rev. 2000 Mar;23 (1):30-3
references: 10809484
references: Virchows Arch A Pathol Anat Histopathol. 1991;418(6):479-83
references: 2058082
references: Br J Surg. 1975 May;62(5):397-400
references: 1139137
references: Acta Neurochir (Wien). 1991;110(1-2):29-32
references: 1882715
references: Epidemiol Rev. 2000;22(1):112-9
references: 10939015
references: Clin Neurol Neurosurg. 1992;94(2):127-31
references: 1324810
references: J Neurosurg. 1981 Feb;54(2):179-86
references: 7452331
references: Surg Neurol. 1985 Sep;24(3):260-2
references: 4023905
references: JAMA. 1999 Sep 8;282(10):954-7
references: 10485680
references: J Neurosurg. 1970 Dec;33(6):632-5
references: 5482794
references: J Neurosurg. 1985 Jan;62(1):139-41
references: 3964846