Delayed presentation of a large frontal epidural hematoma with favorable outcome: A case report and surgical considerations

Delayed presentation of large epidural hematomas (EDHs) is a rare but life-threatening and clinically significant occurrence, often challenging conventional assumptions about the time window for effective surgical intervention. We report a case of a 41-year-old man who presented 17 h after head trauma with progressive headache and mild drowsiness (Glasgow Coma Scale score of 13). Computed tomography revealed a large left frontal EDH measuring 96 mL, with a 10.8 mm midline shift but no associated skull fracture. Emergency left frontal craniotomy and hematoma evacuation were performed. Post-operative imaging confirmed complete evacuation and restoration of midline alignment. The patient made a full neurological recovery within 24 h and was discharged on post-operative day 5 without deficit. This case demonstrates several unusual features: A delayed presentation exceeding 12 h despite a large hematoma volume, a frontal location that may have mitigated early neurological decline, and a favorable outcome after a timely surgical intervention. The absence of a skull fracture suggests a low-energy trauma mechanism, explaining the slower accumulation rate. Clinicians should maintain a high index of suspicion for delayed EDH even after mild or seemingly trivial head injury, particularly when symptoms evolve insidiously. In such cases, early neuroimaging remains essential to avoid catastrophic deterioration. Prompt surgical decompression remains the most important predictor of recovery, regardless of the delay in presentation. This report emphasizes that large frontal EDHs can occasionally progress slowly and still have favorable outcomes when treated without delay once identified. Awareness of this atypical presentation is particularly relevant for neurosurgeons in rural or resource-limited settings, where delayed access to advanced imaging and surgical facilities is common.