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An atypical case of head trauma with late onset of contrecoup epidural hematoma,cerebellar contusion,and cerebral infarction in the territory of the recurrent artery of Heubner
Authors:Shinsuke Sato  Tetsuryu Mitsuyama  Akira Ishii  Takakazu Kawamata
Institution:1. Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH;2. Division of General and Thoracic Surgery, Department of Surgery, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH;3. Mayfield Brain & Spine, Cincinnati, OH;4. Division of Pediatric Neurosurgery, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH;5. Comprehensive Children''s Injury Center, Cincinnati, OH;1. Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan;2. Department of Neurology, National Yonezawa Hospital, 26100-1 Oh-Aza Misawa, Yonezawa 992-1202, Japan;3. Department of Neurology, Tohoku University School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai 980-8574, Japan;4. Departments of Neurosurgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
Abstract:We encountered a case of head trauma with very unusual delayed events. A 68-year-old woman was admitted to our hospital after receiving a direct impact to her occiput in a traffic accident. Head CT scans showed a thin acute epidural hematoma in the posterior fossa corresponding to a linear fracture, followed by late onset of contrecoup left frontal epidural hematoma and subsequent cerebellar contusion in the right cerebellar hemisphere. Fifteen days after the trauma, the patient developed mild motor weakness of right upper extremity. MRIs demonstrated an infarct in the territory of the left recurrent artery of Heubner. Although rare, atypical late events in patients with head trauma as reported here should be taken into consideration during subacute follow-up periods.
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