NEUROIMAGES Hourglass brain Figure CT scan showing bilateral acute epidural hematomas causing severe compression of the brain parenchyma, which is deformed into hourglass shape A 50-year-old man was admitted with repeated alcoholic withdrawal seizures and head trauma, followed by coma. CT scan showed large bilateral acute epidural hematomas (figure). Bilateral craniotomy and drainage were performed. Afterward, the patient regained consciousness but remained mute, with spastic tetraparesis and refractory epilepsy. Bilateral epidural hematomas are exceedingly rare, accounting for 2.58% of all epidural hematomas; they cause high mortality and morbidity; and they usually occur after severe head injury, e.g., car accidents.1,2 In this case, chronic alcoholism may have resulted in a mild coagulation disorder, and seizure-induced repeated head trauma provoked bilateral synchronous epidural bleeding. R.M. Guerreiro, MD, P. Fontoura, MD, PhD, Setúbal, Portugal Disclosure: The authors report no disclosures. Address correspondence and reprint requests to Dr. R.M. Guerreiro, Department of Neurology, Centro Hospitalar de Setúbal, Rua Camilo Castelo Branco, 2900 Setúbal, Portugal; rpguerreiro@gmail.com 1. 2. Gorgulu A, Çobanuglu S, Armagan S, Karabagh H, Tevruz M. Bilateral epidural hematoma. Neurosurg Rev 2000;23:30–33. Gelabert-Gonzalez M, Iglésias M, Serranito R, Fernandez J, Garcia A, Martinez R. Hematomas epidurales bilaterales simultáneos. Neurocirugia 2005;16:256–260. Copyright © 2008 by AAN Enterprises, Inc. 149 Hourglass brain R. M. Guerreiro and P. Fontoura Neurology 2008;71;149 DOI 10.1212/01.wnl.0000316809.62935.79 This information is current as of July 7, 2008 Updated Information & Services including high resolution figures, can be found at: http://www.neurology.org/content/71/2/149.full.html References This article cites 2 articles, 0 of which you can access for free at: http://www.neurology.org/content/71/2/149.full.html##ref-list-1 Subspecialty Collections This article, along with others on similar topics, appears in the following collection(s): Alcohol http://www.neurology.org//cgi/collection/alcohol Brain trauma http://www.neurology.org//cgi/collection/brain_trauma Coma http://www.neurology.org//cgi/collection/coma CT http://www.neurology.org//cgi/collection/ct Nonepileptic seizures http://www.neurology.org//cgi/collection/nonepileptic_seizures Permissions & Licensing Information about reproducing this article in parts (figures,tables) or in its entirety can be found online at: http://www.neurology.org/misc/about.xhtml#permissions Reprints Information about ordering reprints can be found online: http://www.neurology.org/misc/addir.xhtml#reprintsus Neurology ® is the official journal of the American Academy of Neurology. Published continuously since 1951, it is now a weekly with 48 issues per year. Copyright . All rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X.