gms | German Medical Science

Objective: Acute epidural hematoma (EDH) commonly occurs in coup head injury with a skull fracture. The EDH is almost always unilateral and arises in the vicinity of the impact site. Acute EDH caused by a contrecoup injury is extremely rare. We report a case of contrecoup EDH associated with a coup EDH.

Methods: A 50-year-old woman was hit by a car while riding a bicycle. She struck the left parietal region of her head on the ground. She was dazed for a few minutes. On admission, she complained of nausea but exhibited no neurological deficits. Skull X-rays revealed a linear fracture of the left temporal bone. Computed tomography (CT) scans demonstrated an acute EDH in the right frontal region due to contrecoup injury, and a thin EDH in the left temporal region due to coup injury. She vomited repeatedly after admission. She became lethargic and exhibited right hemiparesis. CT scans, taken two hours later, revealed enlargement of the left coup EDH. But the right EDH caused by the contrecoup injury did not grow. An emergent evacuation of the enlarged coup EDH was performed. Immediately after the operation, she became alert and the right hemiparesis subsided. The contrecoup EDH was conservatively treated given the absence of enlargement. She was discharged 12 days after the injury without neurological deficits.

Conclusions: In the present case, the contrecoup EDH developed on the corner of the frontal convexity and the skull base that have a small curvature. This small curvature of the inner surface of the cranium might have prompted detachment of the dura from inner table of the skull by the parietal blunt injury, causing the contrecoup EDH.