Author(s): M. Premjit Ray, Kodali Sandhya

BACKGROUND EDH is the commonest emergency in the practice of Neurosurgery. Not all cases of EDH require surgical intervention. Our aim is to study the radiological evaluation which influences the line of management of EDH in Tertiary Care Centre - Rangaraya Medical College, Kakinada. Head injury has become a leading cause of morbidity and mortality all over the world. In India the incidence of head injury has been increasing at a rapid pace. Non-compliance with traffic rules doubled with alcohol consumption, poor condition of the roads and illiteracy are the major reasons for injuries in young individuals more often. MATERIALS AND METHODS This is a prospective study of 2 years duration conducted in Government General Hospital under Rangaraya Medical College, Kakinada, which is a Tertiary Referral Hospital, catering services to two large densely populated districts namely, East (52.86 lakhs) and West (39.36 lakhs) Godavari districts of Andhra Pradesh. All patients were taken up for CT scan at admission. Patients with effacement of ipsilateral ventricle or midline shift to opposite side or mass effect were operated immediately. Patients without the above signs were included in conservative group and after 6 hours, a repeat CT brain was done and after 2 days repeated again. Follow up scan done on 7th day and discharged after regression of symptoms. Repeat scans were done at follow up on outpatient basis again. RESULTS Total of 264 cases of EDH were treated in our hospital with an average follow up period of one month upto one year. Ratio of male to female 6:1 in our study. Conservatively treated cases were 185 & Surgery was done in 79 cases. Commonest location of EDH was temporoparietal region with a rare finding of bilateral EDH in seven patients, EDH in two regions on the same side was noted in one patient. We noted Infratentorial EDH in six cases, in which two patients were operated & four managed conservatively. The range of age of presentation in our study was 3 years to 76 years. Associated parenchymal lesions seen were SAH in 74 patients, SDH in 9 patients and Intracerebral Contusions in 24 patients. Commonly noted associated injuries were limb fractures. Existing medical dyscrasia seen in two patients. The timing of complete resolution: earliest -14 days with an average resolution of 21-46 days. Site of fracture and location of EDH were in the same region except in seven patients who did not have fracture. Two conservatively managed patients in whom EDH increased in volume required surgery after repeat scan done at 6 hours interval duration. CONCLUSION EDH is an emergency in Neurosurgery. Out of 264 cases 79 (29.8%) of EDH patients required surgery in our hospital. Patients with massive EDH expired in post-operative period. Time of presentation is important in predicting the overall post traumatic sequalae.