Traumatic ipsilateral acute extradural and subdural hematoma

Occurrence of concomitant extradural hematoma (EDH) and acute subdural hematoma (SDH) after trauma on the same side is a rare occurrence. EDHs are usually coup lesions, due to direct trauma with seepage of blood from overlying skull fracture or injury to the dural arteries. Acute SDH, on the other hand, is a countercoup injury, due to brain shift causing damage to the cortical bridging veins. In all our cases, the patient presented the following impact with metal rods overhead. The impact force resulted in fracture of the bone, resulting in stripping of underlying dura, along with cortical injury eventually forming EDH and SDH. It is of importance to note the mechanism of injury and the area of major impact in these cases. Overlapping EDH and SDH shall give rise to the characteristic “CT comma sign.” 3, 4 CT comma sign in our series was seen in only one case. During a retrospective analysis of the radiology of the cases, each of the hematomas had an indentation on the cortical side. These cases must undergo urgent surgery with the principal aim of evacuating extradural hematoma and then noting the status of the dura. If the dura is bulging and has a bluish tinge, then the dura must be opened and acute SDH evacuation must be undertaken. Flap must be planned keeping in mind that we may need to undertake a decompressive craniectomy and wherever possible a trauma flap must be planned.