Question

Answer

Epidural Hematoma with mid-line shift from middle meningeal artery injury; see image below for comparison of subdural and epidural

Epidural hematoma

• Blood accumulates between dura and calvarium secondary to trauma; concurrent skull fractures are common
• Middle menial artery is usually involved in the temporal region; other arteries may be involved depending on which area of the skull receives the impact
• Up to one-third of cases present with the "classic" lucid interval from injury and loss of consciousness to a decline in mental status. Diagnosis should be suspected, however, based on mechanism
• Treatment is surgical evacuation, however aggressive medical management of increased intracranial pressure should not be delayed:
  • Head of bed elevated and keep neck mid-line
  • Anti-emetics and analgesics
  • Osmotic agents such as mannitol or hypertonic saline
  • Avoid hypoxia, hypotension, and hyperthermia

References

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