title: A tale of two acute extradural hematomas.
abstract: BACKGROUND
  In much of the Western hemisphere, mortality from traumatic acute extradural hematomas (AEDH) has been drastically brought down toward 0%. This is still not the case however in most developing countries.
  
  
  METHODS
  This report represents a tragi-comic tale of two cases of traumatic AEDH managed by an academic neurosurgeon in a neurosurgically ill-resourced private health facility during a nationwide industrial strike action preventing clinical-surgical care in the principal author's University Teaching Hospital. A young man presented with altered consciousness, Glasgow Coma Score (GCS) 14/15, following a road accident. The cranial computed tomography (CT) scan was obtained only 9 h after its request, long after the man had actually deteriorated to GCS 7/15 with pupillary changes. The neurosurgeon, summoned from the nearby University Teaching Hospital for the operative care of this man, arrived on-site and was about moving the patient into the operative room when he took the final breaths and died, all within 2 h of the belated neuroimaging. This scenario repeated itself in the same health facility just 24 h later with another young man who presented GCS 7/15 and another identical CT evidence of traumatic AEDH. With more financially able relations, the diagnostic/surgical care of this second patient was much more prompt. He made a very brisk recovery from neurosurgical operative intervention. He is alive and well, 5-month postoperative.
  
  
  CONCLUSIONS
  In most low-resourced health systems of the developing countries, a significant proportion of potentially salvageable cases of AEDH still perish from this disease condition.
authors.affiliation: Department of Surgery, Division of Neurological Surgery, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria.
authors.forename: Amos Olufemi
authors.initials: AO
authors.lastname: Adeleye
authors.affiliation: Department of Family Medicine, Molly Specialist Hospital, Ibadan, Nigeria.
authors.forename: Ikechi E
authors.initials: IE
authors.lastname: Jite
authors.affiliation: Department of Family Medicine, Molly Specialist Hospital, Ibadan, Nigeria.
authors.forename: Omolara A
authors.initials: OA
authors.lastname: Smith
keywords: Developing countries; poor health systems; poor outcome; talked and died head injured; traumatic acute extradural hematomas