Development of delayed epidural hematoma.

A 24-year-old man was brought to the emergency room after a beating to the head with a baseball bat. At the time of admission he was noted to have a di lated right pupil and abnormal extensor responses bilaterally. The initial CT scan revea led a large, right, acute, subdural hematoma with appropriate right-to-Ieft sh ift of the midline structures (fig . 1 A) . He underwent a decompressive craniotomy with evacuation of the subdural hematoma. Failure to improve neurolog ically at 24 hr after su rgery led to a repeat CT examination . It revea led a large, left, acute, epidural hematoma (fig . 1 B) . A left frontotemporoparietal craniotomy and evacuation of the c lot was performed . At operat ion a left temporal bone fracture also was noted . The patient made a slow neurologic recovery .