• Marco Fricia, Giuseppe Emmanuele Umana, Gianluca Scalia, Giuseppe Raudino, Maurizio Passanisi, Angelo Spitaleri, and Salvatore Cicero.
• Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy.
• World Neurosurg. 2020 Jan 1; 133: 212-215.

BackgroundDevelopment of a delayed acute epidural hematoma (DEDH) represents a rare event, characterized by a high mortality rate. It is defined as an extradural bleeding not evident at the first brain computed tomography (CT) scan performed after traumatic brain injury but evidenced by further radiologic evaluations.Case DescriptionA 22-year-old male was admitted to our unit after brain injury due to an assault. Immediate brain CT scan revealed a right frontal epidural hematoma (EDH) and a smaller left anterior temporal EDH with multiple, bilateral skull fractures in the frontal, parietal, and temporal bones. Both EDHs were surgically treated in the same session. Another immediate CT scan showed a third left parietal acute DEDH. The patient was retransferred to the operating room for a further left parietal craniotomy and EDH evacuation. The postoperative period was uneventful: the patient effectively improved. After 15 days, the patient left the hospital and was admitted to a rehabilitation center.ConclusionsTo the best of our knowledge, this is the first report of a synchronous acute bilateral EDH with the development of a third DEDH located in a separate site. This finding is certainly related to the presence of multiple and bilateral skull fractures. In our experience, we suggest performing an intraoperative CT scan, if available, to early detect the possible development of DEDH.Copyright © 2019 Elsevier Inc. All rights reserved.

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