Expansion of Contralateral Extradural Hematoma following Mannitol Therapy

Abstract

, Traumatic brain injury can be complicated by edema and mass effect resulting in elevation of the intracranial pressure (ICP), reduction in cerebral perfusion pressure, and global ischemia. 1 The use of osmotic agents (mannitol and hypertonic saline) is recommended to lower the ICP and to improve cerebral blood fl ow to hypoperfused brain regions in patients with traumatic brain injury. 2 Mannitol has traditionally been used as nonsurgical treatment options to control intracranial hypertension, tissue shifts, and ultimately herniation in these patients. 1,3 – 5 A 16-year-old girl sustained traumatic brain injury after being hit by a two-wheeler. She presented to the emergency department (cid:1) 6hours after the incident. She had a history of loss of consciousness for 20minutes, multiple episodes of vomiting, and left ear bleed. There was no history of seizures. On neurological examination, she was opening eyes to call, disoriented, and localizing to pain (E3V4M5). Pupils were bilaterally equal and reacting to light. There were no focal neurological de fi cits. General and systemic examination was unremarkable. A computed tomography (CT) scan of the brain showed thin right fronto-temporo-parietal acute subdural hematoma with mass effect andminimal midlineshift; in addition, therewas a thin temporal extradural hematoma (EDH) of theleft side also ( ► Fig. 1A ). The patient was started on antiedema measures and prophylactic antiepileptics. She regained consciousness thenextdayafteradmissionbutwascomplainingofpersistent