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Prognosis

Prognosis depends on the interval between onset of the space-occupying EDH-induced cerebral compression and the start of surgical decompression; this means that timely diagnosis and treatment are essential to a favorable prognosis. The patient's life can only be saved by early surgical decompression. If performed early enough, this can achieve a complete recovery. The mortality of EDH varies between 0% (Paterniti et al. 1994), 5% (Poon et al. 1992) and 43% (Seelig et al. 1984). Early surgical intervention does not guarantee the patient's survival or complete recovery. The possibility of mistaken diagnosis is just as likely in EDH as in SDH and is discussed below (see p. 130).

Fig. 7.10a-e. The herniation sequelae of space-occupying intra- the hemisphere with discrete lesion of the corpus callosum and cranial (subdural) hemorrhage. a Compression of one hemisphere hemorrhage in the right gyrus cingulus (= subfalcine herniation);

(right) and compression of the contralateral hemisphere (left) in a c extreme basal brain herniation causing hippocampal hemor-

formalin-fixed brain after removing the subdural hemorrhage; rhage (= uncal herniation); d tonsillar herniation; e herniation-in-

b extreme hemispheric shifting as a result of a (right) subdural duced pontine hemorrhage hemorrhage characterized by a flattening of the lateral parts of

Fig. 7.11a-d. Epidural hemorrhage (EDH). a Fracture of the temporal and latero-parietal bone can be associated with a laceration injury to the medial meningeal artery with the sequelae of an epidural hemorrhage; b EDH compress the right hemisphere as the result of a space-occupying process; c EDH leads to an intracranial displacement of the brain parenchyma with d a midline shift from right to left

Fig. 7.11a-d. Epidural hemorrhage (EDH). a Fracture of the temporal and latero-parietal bone can be associated with a laceration injury to the medial meningeal artery with the sequelae of an epidural hemorrhage; b EDH compress the right hemisphere as the result of a space-occupying process; c EDH leads to an intracranial displacement of the brain parenchyma with d a midline shift from right to left

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