epidural hematoma

Pathology

• commonly occurs with a temporal skull fracture tearing the middle meningeal artery
• expansion of the initial hematoma may lead to a mass effect &, in a worse-case senario, cerebral herniation & death
• the brain is generally not significantly injured
• spinal epidural hematoma may occur secondary to surgery
• anticoagulation increases risk

Clinical manifestations

• severe headache
• vomiting
• loss of consciousness
• the patient may have a lucid interval after loss of consciousness until the hematoma expands resulting in rapid deterioration

Radiology

• computed tomography
  • dome-shaped hyperintensity (acute)
• magnetic resonance imaging (MRI)
  • contrast enhancement on T1-weighted images
  • may be hyperintense on T2-weighted scan

Complications

• cerebral herniation through tentorium cerebelli
  • stupor or coma, cranial nerve 3 palsy & contralateral hemiparesis may herald

Differential diagnosis

• subdural hematoma
  • clinical deterioration is generally slower over days to weeks, but it is often difficult to clinically distinguish

Management

• if patient is anticoagulated
  • stop anticoagulant
  • reverse anticoagulation
• neurosurgical consultation
  • without immediate surgical evacuation, patients can die within a matter of hours
  • with immediate sugical evacuation, prognosis is generally good

More general terms

• intracranial hematoma

Additional terms

• middle meningeal artery
• subdural hematoma