Search

Extradural hematoma (EDH) generally occurs in the site of impact, that is, coup injury site. EDH is associated with fracture of skull in many a times due to direct impact. However, EDH in counter coup site is a rare occurrence. Hardly, yet, 12 cases have been reported including this case. Here, we reported a case of a 22-year-old male of contrecoup acute EDH who had sustained head injury due to fall from bike. Physical examination revealed direct impact at the left occipito-parietal region with laceration of scalp and bruise with transient loss of consciousness at the time of injury. There was no evidence of impact on the right side of his head. Computed tomography scan revealed an EDH in the right fronto-temporal region without any bone fracture on bone windows. On intraoperative exploration, it is found that there was coronal suture diastasis with small subgaleal hematoma and right fronto-temporal extradural hematoma. The evacuation of EDH was done. The patient discharged on 3 rd postoperative day. It can be concluded that direct impact on head causes exactly opposite hit of brain, and compensatory rebound causes a negative pressure in between the layers causing disruption of vessels and potential accumulation of blood. This mechanism mostly favors for acute subdural hematoma due to compact attachment of dura with cranium. However, in this case, diastasis of coronal suture due to transmitted force is the cause of accumulation of blood extradurally in relatively loosely adhered dura in fronto-temporal region where a potential negative pressure space is created by contrecoup injury., Competing Interests: There are no conflicts of interest.

Even if human beings are the most intelligent among all living beings, they are still not immune to attack from wild animals. Human contact with bears has become more frequent as their habitat is being endangered by frequent deforestation. The sloth bear is one of the few bear species found in India, especially in the hilly areas of Southern Odisha. Bears are highly intelligent and omnivorous animals with long claws coupled with powerful shoulder. Here, we describe the tale of a poor tribal male's encounter with a sloth bear resulting in critical injuries to face, scalp, skull bone, with brain matter fungating-out of the skull. We immediately went for debridement of the, bulged-out contused brain matter and opted for delayed repair of scalp defect with antero-lateral thigh free-flap to save him from fatality along with an acceptable cosmetic repair of the defect., Competing Interests: There are no conflicts of interest.