Teaching image withheldThe image will be revealed when it becomes clinically available in the case.
Operative image obtained during emergent craniectomy, showing an exposed cranial surgical field with a large epidural hematoma being evacuated over the cerebral surface. • TEACHING IMAGE
Massive Epidural Hematoma Requiring Emergent Decompression
SCENARIO
A 45-year-old woman is brought to the emergency department after an unwitnessed fall down a flight of stairs while intoxicated. She has a GCS of 5, unequal pupils with a sluggishly reactive left pupil, and blood in the external auditory canal. She is intubated, cervical-spine precautions are maintained, and initial resuscitation is performed. After stabilization sufficient for imaging, head CT demonstrates a large acute epidural hematoma with marked mass effect, midline shift, and concern for impending herniation. Neurosurgery is contacted, and the patient is transferred emergently to the operating room. The operative image becomes available after cranial exposure and evacuation have begun.