The importance of serial neurologic examination and repeat cranial tomography in acute evolving epidural hematoma

Computed tomography (CT) has: revolutionized the diagnosis and management o f head-injured patients, and its increasing availability has led to its lib eral use. CT scanning provides excellent anatomic detail of the brain as fi xed static images, but the dynamic nature of human physiology means that ma ny injury patterns will evolve in time. We describe an 8-year-old child who had fallen 8 feet from a tree. He had a brief loss of consciousness but a normal neurologic evaluation on arrival to the emergency department (ED), N e underwent expedited cranial CT scanning, which revealed no acute brain in jury. Two and one half hours later, the patient had a mild depression in co nsciousness, prompting a second CT scan in the ED, which revealed an acute epidural hematoma. He had acute surgical evacuation of the hematoma and mad e a full neurologic recovery. This case illustrates that a single early CT examination may at times provide a false sense of security and underscores the importance of serial neurologic examinations.