Late decompensation after a prolonged lucid interval in chronic posterior fossa extradural hematoma.

A 6-year-old boy presented in an unconscious state with history of holocranial headache and vomiting of two days duration. There was no history of seizures or fever. He was afebrile but tachypneic, was localizing with both upper limbs, with no eye opening or verbal response (Glasgow Coma Scale of E1M5V1). Pupils were equal in size and reacting to light. Both plantars had withdrawal response. There was a history of fall, 3 weeks ago, following which he lost consciousness for 20 minutes and was then apparently normal except for complaints of occipital pain and was treated conservatively. Computed tomography (CT) scan revealed a left-sided hypodense extra-axial mass in the posterior fossa compressing the left cerebellar hemisphere and brain stem effacing the perimesencephalic cistern with 4th ventricular shift (Fig 1). His hematological parameters were normal. He underwent left cerebellar burr hole and evacuation of the hematoma under general anesthesia. Intraoperatively, altered liquid blood under pressure was drained and underlying dura was normal. A diagnosis of chronic extradural hematoma (EDH) was made. He regained consciousness the following day and was neurologically normal at follow-up, two months later.