- Clinical science
Epidural hematoma occurs as a result of head trauma and subsequent acute hemorrhage, primarily from the middle meningeal artery between the skull and the dura mater. Typical symptoms are due to compression of the brain and appear after a lucid interval that follows an initial loss of consciousness. Increased intracranial pressure leads to a decline in mental status and anisocoria, in which the ipsilateral pupil is dilated. Diagnosis is confirmed by CT (biconvex, hyperdense, sharply demarcated mass). Emergency treatment is necessary and involves neurosurgical opening of the skull and hematoma evacuation.
- Sex: ♂ > ♀ (4:1)
- Peak incidence: 20–30 years
Epidemiological data refers to the US, unless otherwise specified.
- The epidural space is a potential space between the dura mater and the calvarium.
- Head trauma (usually severe) → skull fracture (often temporal bone) → rupture of a middle meningeal artery → ↑ intracranial pressure → CN III palsy; , herniation
- Nontraumatic causes of epidural hematoma are very rare.
Typical clinical course
- Initial loss of consciousness following head trauma
- Temporary recovery of consciousness (lucid interval)
- Renewed decline in mental status
- Elevated intracranial pressure
- Clinical signs of skull fracture (e.g., local hematoma, swelling, laceration)
Symptoms may appear directly after trauma or after a lucid interval!
- Imaging of choice: noncontrast head CT scan
|Epidural hematoma||Subdural hematoma||Subarachnoid hemorrhage||Intracerebral hemorrhage||Ischemic stroke|
|Etiology|| || || |
|Clinical features|| || || || |
|CT findings|| || |
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The differential diagnoses listed here are not exhaustive.
- Initial resuscitation
- Management of elevated intracranial pressure
- First-line: urgent craniotomy and hematoma evacuation
- Second-line: emergency burr hole
Epidural hematoma is a medical emergency in which emergency craniotomy is essential!
- Mortality rate: depends on preoperative condition of patient
- Factors associated with a worse prognosis
- Low Glasgow Coma Scale scores before surgical intervention
- Delay in treatment
- Age > 75 years
- Urgent neurosurgery consult for consideration of surgical intervention and ICP monitoring
- Airway management: anesthesiology consult
- Establish IV access.
- Identify and treat any underlying coagulopathy.
- Identify and treat any complications (e.g., elevated ICP, seizures)
- Euthermia: antipyretics for fever
- Euvolemia: IV fluids for hypovolemia
- Identify and treat the underlying cause.
- Close observation and GCS monitoring
- Admit to neurosurgical ICU.
- Repeat CT head 
- If clinically stable: Repeat within 4–8 hours.
- In the case of clinical deterioration or new neurologic deficits: Repeat immediately.