Acute Traumatic Epidural Hematoma with Significant Midline Shift Following a Helmetless Motorcycle Accident: A Case Report on Emergent Craniotomy and Favorable Neurological Recovery in a Young Adult
Downloads
Traumatic epidural hematoma (EDH) is a neurosurgical emergency commonly observed in young men following high-energy head trauma, particularly motorcycle-related traffic accidents. Although EDH accounts for approximately 8% of traumatic brain injuries, timely surgical evacuation is associated with favorable neurological outcomes, whereas delayed diagnosis or treatment may result in rapid neurological deterioration and death. An 18-year-old male patient presented to the emergency department following a motorcycle crash without a helmet, with loss of consciousness, vomiting, and a laceration in the left supraorbital region. On admission, his Glasgow Coma Scale (GCS) score was 6 (E1V1M4), accompanied by anisocoria (pupillary diameters of 2 mm and 4 mm) and sluggish pupillary light responses. Noncontrast computed tomography (CT) of the head revealed a well-defined, biconvex hyperdense extra-axial collection in the left frontotemporoparietal region, associated with a 1.6-cm rightward midline shift, consistent with acute EDH. The patient underwent emergency craniotomy and hematoma evacuation. Postoperatively, his neurological status progressively improved, with the GCS score increasing from 6T to 15 within four days. He was subsequently extubated, transferred from the intensive care unit, and discharged home with a favorable neurological outcome. At outpatient follow-up, the surgical wound had healed well. This case illustrated the characteristic clinical and radiological features of acute traumatic EDH and emphasized the importance of rapid assessment, early neuroimaging, and timely surgical evacuation in preventing secondary brain injury. Despite the patient's initially low GCS score and substantial midline shift, favorable neurological recovery was achieved following emergency surgical intervention, consistent with evidence supporting early hematoma evacuation as a critical modifiable factor associated with improved survival and functional outcomes in patients with traumatic EDH.
AW, N., & NUE, M. (2025). The epidemiology of motorcycle-related acute traumatic brain injury: the NOMADEN study.
Cremonini, C., Lewis, M., MD, W., ER, B., Inaba, K., & Demetriades, D. (2020). Traumatic epidural hematomas in the pediatric population: clinical characteristics and diagnostic pitfalls. Journal of Pediatric Surgery, 55(9), 1773–1778. https://doi.org/10.1016/j.jpedsurg.2020.05.011
DS, K., & JG, A. (2016). Epidural hematoma.
EH, R., Sharma, S., Kashif, M., Maheshwari, S., RP, S., & AK, K. (2025). Clinical and Radiological Criteria for Surgery in Posttraumatic Extradural Hematoma: An Update from Central India. Indian Journal of Neurotrauma, 20(1), 105–111. https://doi.org/10.1055/s-0044-1795164
Faried, A., AM, B., AN, S., YW, H., & MZ, A. (2017). Characteristics of moderate and severe traumatic brain injury of motorcycle crashes in Bandung, Indonesia.
Irie, F., R, L. B., Kenardy, J., Bellamy, N., Tetsworth, K., & Pollard, C. (2011). Epidemiology of traumatic epidural hematoma in young age.
JC, G. (2013). The lucid interval associated with epidural bleeding: evolving understanding.
JH, K., WK, Y., TH, K., & JH, K. (2022). Clinical features and treatment strategies for vertex epidural hematoma: a systematic review and meta-analysis from individual participant data. Neurosurgical Review, 45(1), 819–830. https://doi.org/10.1007/s10143-021-01589-z
Kourouklari, E., Charalambous, D., Faropoulos, K., & Fotakopoulos, G. (2022). Epidural Hematoma: The Outcome of Glucocorticoids’ Complementary Use to Surgical Treatment. Cureus, 14(2), e22607. https://doi.org/10.7759/cureus.22607
Marhold, F., Prihoda, R., Pruckner, P., Eder, V., Glechner, A., Klerings, I., Gombos, J., Popadic, B., Antoni, A., Sherif, C., & Scheichel, F. (2023). The importance of additional intracranial injuries in epidural hematomas: detailed clinical analysis, long-term outcome, and literature review in surgically managed epidural hematomas. https://doi.org/10.3389/fsurg.2023.1188861
Montemurro, N., Santoro, G., Marani, W., & Petrella, G. (2020). Posttraumatic synchronous double acute epidural hematomas: Two craniotomies, single skin incision. Surgical Neurology International, 11, 435. https://doi.org/10.25259/SNI_697_2020
MR, B., Chesnut, R., Ghajar, J., Gordon, D., Hartl, R., DW, N., Servadei, F., BC, W., & Group, W. J. S. M. of T. B. I. A. (2006). Surgical management of acute epidural hematomas.
Nakamura, S., Yoshida, S., Matsuda, H., Yahata, T., Inokuchi, K., Maru, T., Ogihara, S., Saita, K., & Oya, S. (2023). Ultraearly Hematoma Evacuation (<12 Hours) Associated with Better Functional Outcome in Patients with Symptomatic Spontaneous Spinal Epidural Hematoma. World Neurosurgery, 171, e859–e863. https://doi.org/10.1016/j.wneu.2023.01.008
Peng, D., Yan, M., Liu, T., Yang, K., Ma, Y., Hu, X., Ying, G., & Zhu, Y. (2022). Prognostic Factors and Treatments Efficacy in Spontaneous Spinal Epidural Hematoma: A Multicenter Retrospective Study. Neurology, 99(8), e843–e850. https://doi.org/10.1212/WNL.0000000000200844
Pisic?, D., Volovici, V., JK, Y., TA, van E., HF, den B., T, V. V., Haitsma, I., Nieboer, D., AJ, M., EL, Y., EW, S., WC, P., CMF, D., DK, M., GT, M., AIR, M., & Investigators, L. H. C.-T. P. and. (2024). Clinical and imaging characteristics, care pathways, and outcomes of traumatic epidural hematomas: a Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury study. https://doi.org/10.1227/neu.0000000000002982
Rahimi, A., JA, C., Ammar, A., NA, S., Rolle, M., RA, M., & KB, P. (2022). The unmet global burden of cranial epidural hematomas: a systematic review and meta-analysis.
RM, R., Priyanto, B., A, A. F., & AB, S. (2019). Toward zero mortality in acute epidural hematoma: a review in 268 cases, problems and challenges in the developing country.
SS, D., MA, J., MM, A. B., Jarrar, S., Jaradat, A., AS, A., MK, A., AF, H., EA, H., OF, J., MA, A., & Abdallah, A. (2024). Operative versus non-operative management of posterior fossa epidural hematoma: A systematic review and meta-analysis. Neurochirurgie, 70(5), 101578. https://doi.org/10.1016/j.neuchi.2024.101578
Vastani, A., AB, M., AK, K., Bartram, J., Shaheen, S., Rajkumar, S., China, M., JP, L., Bleil, C., Bell, D., Thomas, N., Malik, I., & Grahovac, G. (2023). Prognostic factors and surgical outcomes of spontaneous spinal epidural haematoma: a systematic review and meta-analysis. Neurosurgical Review, 46(1), 21. https://doi.org/10.1007/s10143-022-01914-0
Yang, C., Hui, J., Xie, L., Feng, J., & Jiang, J. (2022). Comparative effectiveness of different surgical procedures for traumatic acute epidural haematoma: study protocol for Prospective, Observational Real-world Treatments of AEDH in Large-scale Surgical Cases (PORTALS-AEDH). BMJ Open, 12(3), e051247. https://doi.org/10.1136/bmjopen-2021-051247
Copyright (c) 2026 Suhada Akmal Al Kausar, Ilham Rizky Ernawan
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-ShareAlike 4.0 International (CC-BY-SA). that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
