Contrecoup epidural hematoma without skull fracture after decompression of impact side acute subdural hematoma

• Contrecoup acute epidural hematoma (AEDH) without skull fracture is extremely rare. • he mechanism of contrecoup AEDH injury without fracture remains unclear, but negative pressure applied to the dura mater has been hypothesized. • Continuous monitoring of intracranial pressure and evaluation of neurological deficits may be crucial for detecting the clinical course. Contrecoup acute epidural hematoma (AEDH) without skull fracture is extremely rare. We report a pediatric case with a right frontal head injury resulting in a right acute subdural hematoma (ASDH) without skull fracture. Emergency surgery to evacuate the ASDH and monitor ICP was performed. However, 3.5 h later, elevated ICP and follow-up CT revealed a new contralateral AEDH. Urgent removal was conducted, with no skull fracture observed. Following intensive postoperative management, the patient was discharged without neurological deficits.Only 21 cases of contrecoup AEDH without skull fracture have been reported, and just two occurred after surgery for ASDH on the impact side. This case highlights the clinical features of this rare condition, supported by a literature review.