Enlargement of intracerebral haematomas following surgical removal of epidural haematomas.

Postoperative follow-up computerized tomographic (CT) scans were performed in 16 cases of acute epidural haematomas to assess the efficacy of surgical treatment. Particular attention was paid to postoperative intracerebral haematomas that were detected in four cases on the preoperative CT scans. The intracerebral haematomas were found to have enlarged in all four cases on CT scans performed immediately after removal of the epidural haematomas. In the other 12 patients in whom no apparent abnormalities other than epidural haematomas were detected on preoperative CT scans, postoperative CT scans did not show development of intracerebral bleeding. The results indicate that bleeding may be encouraged in areas of intracerebral haemorrhage when coexisting epidural haematomas are evacuated. The possible pathophysiology of enlargement of intracerebral haematomas after decompression is discussed.