title: Contralateral extraaxial hematomas after urgent neurosurgery of a mass lesion in patients with traumatic brain injury.
abstract: OBJECTIVE
  The development of a contralateral extraaxial hematoma has repeatedly been described in small series and descriptive studies. However, the evidence available to date is limited.
  
  
  OBJECTIVE
  To evaluate the incidence and risk factors leading to the development of a contralateral extraaxial hematoma and to describe the characteristics of cases.
  
  
  METHODS
  A retrospective cohort study with prospective data collection was undertaken. All patients admitted to an intensive care unit (ICU) from 2006 to 2010 were studied. The inclusion criteria were as follows: severe trauma [Injury Severity Score (ISS ≥ 16)], neurosurgery (NeuroSx) in the first 24 h. The following were excluded: subacute/chronic subdural hematomas, first bilateral NeuroSx. Cases were those who required immediate contralateral NeuroSx after the first NeuroSx due to the occurrence of a new extraaxial injury or significant growth of a previous one. Controls were those patients those who did not require second NeuroSx or who required reoperation due to ipsilateral lesions. The variables considered were: demographics, neurological assessment, traumatic injuries and severity, image and surgical findings, clinical course, and outcome. Statistics analysis comprised descriptive, inferential, and multivariate analysis by logistic regression.
  
  
  RESULTS
  A total of 120 patients were included, among which there were 11 cases (incidence 9.2 %). The cases showed a significantly higher frequency of coma or severe traumatic brain injury (TBI) at admission, contralateral injury and contralateral skull fracture in the preoperative computed tomography (CT) scan, as well as decompressive craniectomy. There were no significant differences in the severity scores, clinical course, or outcomes. The presence of contralateral fracture was identified as an independent risk factor [relative risk (RR) 47.9, 95 % confidence interval (CI) 5.2-443].
  
  
  CONCLUSIONS
  Contralateral extraaxial hematoma is a rare entity, although it has a high mortality rate. Therefore, it requires a high index of suspicion, especially in patients with severe TBI, with minimal contralateral injury and mainly with contralateral skull fracture on the initial CT scan.
authors.affiliation: Intensive Care Medicine Service, Trauma Intensive Care Unit, Hospital Universitario 12 de Octubre, Madrid, Spain. makalyconru@hotmail.com.|, Paseo de Las Acacias 30, block 4, floor 8th-A, 28005, Madrid, Spain. makalyconru@hotmail.com.
authors.forename: J L
authors.initials: JL
authors.lastname: Flordelís Lasierra
authors.affiliation: Intensive Care Medicine Service, Trauma Intensive Care Unit, Hospital Universitario 12 de Octubre, Madrid, Spain. cgarciaf.hdoc@salud.madrid.org.
authors.forename: C
authors.initials: C
authors.lastname: García Fuentes
authors.affiliation: Intensive Care Medicine Service, Trauma Intensive Care Unit, Hospital Universitario 12 de Octubre, Madrid, Spain. dtoral.hdoc@salud.madrid.org.
authors.forename: D
authors.initials: D
authors.lastname: Toral Vázquez
authors.affiliation: Intensive Care Medicine Service, Trauma Intensive Care Unit, Hospital Universitario 12 de Octubre, Madrid, Spain. murgchico@yahoo.es.
authors.forename: M
authors.initials: M
authors.lastname: Chico Fernández
authors.affiliation: Intensive Care Medicine Service, Trauma Intensive Care Unit, Hospital Universitario 12 de Octubre, Madrid, Spain. sbermejo.hdoc@salud.madrid.org.
authors.forename: S
authors.initials: S
authors.lastname: Bermejo Aznárez
authors.affiliation: Intensive Care Medicine Service, Trauma Intensive Care Unit, Hospital Universitario 12 de Octubre, Madrid, Spain. ealted.hdoc@salud.madrid.org.
authors.forename: E
authors.initials: E
authors.lastname: Alted López
keywords: Alternating delayed intracranial hematomas; Bilateral acute epidural hematoma; Contralateral acute epi- or subdural hematoma; Delayed post-traumatic extracerebral hematomas; Traumatic brain injury
references.citation: Neurol Res. 2004 Oct;26(7):763-6
references.pmid: 15494119
references.citation: Br J Neurosurg. 2005 Dec;19(6):490-4
references.pmid: 16574562
references.citation: Neurosurgery. 1980 Dec;7(6):608-10
references.pmid: 7207757
references.citation: Surg Neurol. 2003 Jul;60(1):23-30; discussion 30
references.pmid: 12865006
references.citation: Neurosurg Focus. 2009 Jun;26(6):E7
references.pmid: 19485720
references.citation: Neurol Med Chir (Tokyo). 1991 Dec;31(13):927-30
references.pmid: 1726254
references.citation: J Trauma. 2008 Dec;65(6):1298-302
references.pmid: 19077617