Traumatic Extradural Hematoma Presenting as Monoplegia in an Elderly Female

Contralateral weakness following cranial injury has been emphasized as a clinical manifestation of extradural hematoma (EDH) since long.1 Only few reported cases where patients with traumatic extradural hematoma presented with monoplegia.2,3 A 53 year female presented with history of a fall in the bathroom in the morning of one day duration. Following the fall she had transient loss of consciousness and recovered. After 8-10 hours of the incident she had two episodes of vomiting and was complaining of mild headache. She was taken to la local hospital where the attending physician noted the weakness of right lower limb. An urgent CT scan brain was performed and it showed a large extradural hematoma over left high parietal region with mass effect and adjacent cerebral edema (Fig. 1). At the time of examination in emergency room at our hospital the patient was conscious, obeying commands and opening her eyes spontaneously. Her cranial nerves were normal. Pupils were bilateral equal and reacting to light. She had grade 1/5 power in right lower limb. Power in other limbs was normal. Deep tendon reflexes were exaggerated in right lower limb. Plantar were flexor. In view of focal weakness the patient underwent left parietal craniotomy and evacuation of a thick extradural blood clot. Over a period of 72 hours after surgery the patient recovered completely in the power of the right lower limb.