Supra- and Infratentorial Epidural Hematoma as an Acute Complication of Traumatic Brain Injury

A BSTRACT Epidural hematoma (EDH) is a rare brain injury complication, accounting for 1%–4% of cases. Supra- and infratentorial EDH (SIEDH) is particularly rare and challenging to diagnose due to nonspecific symptoms. Rapid deterioration can lead to life-threatening foramen magnum herniation, necessitating prompt treatment. A 27-year-old male presented unconscious after a traffic accident. He vomited three times without seizures. He hit the back of his head on asphalt without a helmet. Assessment showed a Glasgow Coma Scale of E3V4M6, cephalhematoma in the left occipital region, and otorrhea from the left ear. Diagnosed with SIEDH, he underwent a craniotomy. Postsurgery, he healed well and was discharged after 7 days with no remaining hematoma on the brain computed tomography (CT) scan. SIEDH is very rare, constituting <2% of all EDH cases, and lacks characteristic symptoms. A significant indicator is a fracture line crossing the lateral sinus. SIEDH typically results from occipital deceleration injuries associated with occipital bone fractures or lambdoid suture separation. Craniotomy for hematoma evacuation is the gold standard treatment. CT scans are recommended for all patients with occipital trauma, regardless of symptoms. EDH is a neurosurgical emergency. Due to the rarity and nonspecific symptoms of SIEDH, vigilance in diagnosing occipital injuries is crucial. Early CT monitoring and timely surgery can reduce SIEDH mortality and morbidity.