EPIDURALHEMATOMA
■ Usually associated with skull fracture after blunt trauma (see Figure 3.2)
■ Classically an injury to the middle meningeal artery, but epidurals may
occur in other locations
■ Arterial bleeding results in rapid expansion.
■ CT shows biconvex opacity usually at temporo/temporoparietal area.
■ Classically presents with lucid interval after initial LOC followed by recur-
rence of unconsciousness from expanding hematoma
■ A surgical emergency: Evacuation is required unless very small.
SUBDURALHEMATOMA
■ Caused by tearing of bridging veins (see Figure 3.3)
■ Common in the elderly and alcoholics because of atrophy and increased
intracranial space, leading to increased movement of the brain and shearing
forces on bridging veins; may be associated with minor or no known trauma
■ Crescent-shaped hematoma on CT: Bright if acute, dark if chronic
(>14days)
■ Surgical intervention usually required for acute (< 24 hours) and subacute
(< 2 weeks) bleeds, and any bleed associated with a change in mental status
or significant midline shift
Basilar Skull Fracture
Most commonly through the petrous portion of temporal bone
TRAUMAFIGURE 3.2. Epidural hematoma.
(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski JS.Emergency
Medicine:A Comprehensive Study Guide, 6th ed. New York: McGraw-Hill, 2004:1567.)