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Case Reports
. 2018 Dec 3;11(1):bcr2018227525.
doi: 10.1136/bcr-2018-227525.

Rare occurrence of a huge traumatic extradural haematoma in a patient with an ipsilateral sylvian arachnoid cyst

Haider Tawfeeq Alhillo  1 , Hatem Azet Sadik  2 , Teeba N Gheni  3 , Samer S Hoz  1
Affiliations
Case Reports

Rare occurrence of a huge traumatic extradural haematoma in a patient with an ipsilateral sylvian arachnoid cyst

Haider Tawfeeq Alhillo et al. BMJ Case Rep. .

Abstract

A man, a teenage victim of an assault to the head, presented to the emergency department, in Baghdad, with a Glasgow Coma Score of 4/15 (E1 M2 V1) and total right-sided paralysis. CT of the brain revealed a large-left sided frontotemporoparietal extradural haematoma with the presence of an ipsilateral sylvian arachnoid cyst deep to the haematoma. Urgent surgical evacuation of the haematoma was performed, leaving the arachnoid cyst intact. The patient improved and gained full consciousness within 4 days.Three years after the initial trauma, the patient has remained well. This case required a thorough discussion of the surgical options, in particular whether to intervene with the associated cyst, and whether any intervention with the cyst should be performed in the same or future operations. This dilemma forms the basis of the discussion in the following report.

Keywords: neurosurgery; trauma CNS /PNS.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Preoperative brain CT scan, showing a large left-sided frontotemporoparietal extradural haematoma with the presence of an ipsilateral sylvian arachnoid cyst (Galassi grade II) deep to the location of the haematoma, causing midline shift of more than 2 cm.
Figure 2
Figure 2
Diagram of preoperative brain CT scan, showing the extradural haematoma (red) and the arachnoid cyst (blue). Illustration by TNG.
Figure 3
Figure 3
Immediate postoperative brain CT scan, showing near complete evacuation of haematoma with improvement of the preoperative midline shift and an intact sylvian arachnoid cyst.
Figure 4
Figure 4
Diagram of postoperative brain CT scan, showing the arachnoid cyst (blue). Illustration by TNG.
See this image and copyright information in PMC

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