Subdural Hematoma Hidden by Acute Epidural Hematoma: The First Report of Two Cases

Background and Importance: Epidural hematoma (EDH) and subdural hematoma (SDH) are intracranial emergencies and are extremely lethal if not treated promptly. The coexistence of both of these entities in a patient with traumatic brain injury (TBI) leads to a catastrophe of events. Occurrence of both EDH and SDH, on the same side after single trauma is extremely rare. Sometimes, the EDH volume compresses underlying SDH, which in turn leads to radiological obliteration of SDH, leading to misjudgment in surgical planning. Case Presentation: The authors present two cases of TBIs, in which patients were initially operated on EDH, but later, postoperative scans revealed SDH on the same side, which was not visible in preoperative scans. Identification of SDH in postoperative scans prompted a second surgery. Conclusion: EDHs and SDHs are fatal types of TBIs if left untreated. A large-sized hematoma needs surgical evacuation as early as possible. Intraoperative dural pulsation and bulge determine the decision for durotomy. In both index cases, delay in presentation, extent of primary brain injury, and radiological limitations in diagnosing both EDH and SDH leading to further delay in the complete evacuation of hematoma were the chief reasons for the poor prognosis. Through this article, the authors want to emphasize the fact that surgeons should consider this type of radiological phenomenon, which in turn is useful in maximizing the limited resources of hospitals and minimizing the surgical burden of the patients.