Epidural Hematoma

Leyla Azmoun, MD
Piran Aliabadi, MD
B Leonard Holman, MD

November 14, 1995

Presentation

A 31-year-old woman was brought to the emergency room by an ambulance after being struck by a car. She was initially responsive at the scene but subsequently lost consciousness and had to be intubated. Her vital signs were stable and preliminary examination did not show any sign of abdominal injury or open fractures. Her pupils were equal and reactive and she responded to painful stimuli. Portable radiographs of the chest and lateral cervical spine were unremarkable.

Imaging Findings

Noncontrast CT of head

Computed tomography (CT) of the head obtained without intravenous contrast enhancement shows a biconvex high-attenuation epidural hematoma adjacent to the right frontal lobe (arrows). The lesion extends superiorly to the level of the body of the lateral ventricle (arrow) and inferiorly to the roof of the right orbit (arrow). Mild mass effect is exerted on the subjacent brain parenchyma. A fracture is visible extending through the right side of frontal bone (arrow) to the roof of the right orbit (arrow) with associated extracranial soft tissue swelling (arrow).

Diagnosis

epidural hematoma

Discussion

Epidural hematomas are seen in 1-4% of patients with intracranial trauma but they account for 10% of fatal injuries. Laceration of the middle meningeal artery or a dural venous sinus by a skull fracture is responsible for 85-95% of patients with epidural hematomas; the remainder have venous bleeding or middle meningeal artery tear without a fracture. Ninety-five percent of epidural hematomas are unilateral and supratentorial, commonly occurring in the temporoparietal area. They are located between the skull and dura and have a characteristic biconvex or lentiform configuration on CT scans. Two thirds of acute epidural hematomas are hyperdense on CT; one third contain hypodense areas secondary to active bleeding. The overall mortality with epidural hematomas is 5%, and poor outcome is often due to delayed diagnosis or late surgical intervention.

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