Isodense Acute Epidural Hematoma in an Anemic Patient – Diagnostic and Therapeutic Trap: A Case Report

  • Sajid Khan Department of Neurosurgery, Prime Teaching Hospital, Warsak Road, Peshawar
  • Musawer Khan Mardan Medical Complex, Mardan, KPK – Pakistan
  • Naeem-ul- Haq Mardan Medical Complex, Mardan, KPK – Pakistan
  • Mumtaz Ali Department of Neurosurgery, Prime Teaching Hospital, Warsak Road, Peshawar
  • Muhammad Ishaq Mardan Medical Complex, Mardan, KPK – Pakistan
Keywords: Head trauma, acute epidural hematoma


Post-traumatic acute epidural and subdural hematoma is a common neurosurgical emergency. Epidural or extradural hematoma is an accumulation of blood between the skull and dura mater, mostly appears asa hyperdense biconvex shape on computed tomography (CT) scan. In our present study, weencountered a case of an eight years old malechild brought to the hospital with head trauma in aroad traffic accident. Initial CT scan revealed an epidural hematoma, which appeared isodense rather than the usual hyperdense presentation. This unusual presentation was due to low hematocrit (HCT). Thisparticular presentation poses a diagnostic dilemma and can compromise patient managementultimately leading to treatment failure.  Here, we present a case report about diagnosing and managing an anemic patient with traumatic isodense acute epidural hematoma.


1. Urban JE, Whitlow CT, Edgerton CA, Powers AK, Maldjian JA, Stitzel JD. Motor Vehicle Crash-Related Subdural Hematoma from Real-World Head Impact Data. J Neurotrauma, 2012; 29 (18): 2774-2781.
2. Kurland D, Hong C, Aarabi B, Gerzanich V, Simard JM. Hemorrhagic Progression of a Contusion after Traumatic Brain Injury: A Review. J Neurotrauma, 2012; 29 (1): 19-31.
3. Mendonca R, Lima TTF, Dini LI, Krebs CLL. Bilateral Isodense Epidural Hematoma Case report. Arq Neuropsiquiatr. 2005; 63 (3-B): 862-863.
4. Lobato RD, Gomez PA, Nunez AP, Arrese I. Hyperacute epidural haematoma isodense with the brain on computed tomography. Acta Neurochir (Wien), 2004; 146 (2): 193-194.
5. Heit JJ, Iv M, Wintermark M. Imaging of
Intracranial Hemorrhage. J Stroke, 2017; 19 (1): 11-27.
6. Computed Tomography (CT) of the Brain. Basics.htm. Accessed March 25, 2021.
7. Broder J, Preston R. Imaging the Head and Brain. In: Diagnostic Imaging for the Emergency Physician. Elsevier; 2011: 1-45.
8. Lev MH, Gonzalez RG. CT Angiography and CT Perfusion Imaging. In: Brain Mapping: The Methods. Elsevier; 2002: 427-484.
9. Lufkin RB, Hanafee W. Magnetic resonance imaging of head and neck tumors. CANCER METASTASIS Rev. 1988; 7(1): 19-38.
10. Bruni SG, Patafio FM, Dufton JA, Nolan RL, Islam O. The Assessment of Anemia from Attenuation Values of Cranial Venous Drainage on Unenhanced Computed Tomography of the Head. Can Assoc Radiol J. 2013; 64 (1): 46-50.
11. Hara T, Matoba N, Zhou X, et al. Automated detection of extradural and subdural hematoma for contrast-enhanced CT images in emergency medical care. In: Giger ML, Karssemeijer N, eds. Medical Imaging 2007: Computer-Aided Diagnosis, 2007; 6514: 651432.
12. Tapiero B, Richer E, Laurent F, Guibert-Tranier F, Caillé JM. Post-traumatic extradural haematomas. CT diagnosis and features. J Neuroradiol. 1984; 11 (3): 213-226. Accessed March 25, 2021.
Case Reports