Neurology
Summary
An epidural hematoma is a traumatic accumulation of arterial blood located between the dura mater and the skull. This type of hematoma often arises from an injury to the middle meningeal artery, typically due to a temporal bone fracture. The classical presentation of an epidural hematoma is an initial loss of consciousness followed by a lucid interval, which can span several hours, folllowed by a swift neurologic deterioration. However, its clinical manifestation can range widely and can include symptoms like headache, nausea/vomiting, confusion, focal neurological deficits (like hemiplegia, hemisensory losses, or aphasia), seizures, and even coma. Two vital signs of acute increased intracranial pressure (ICP) include Cushing's triad (characterized by irregular breathing patterns, bradycardia, and hypertension) and the "blown pupil" or anisocoria, which denotes an ipsilateral pupil that is fixed and dilated, signaling the danger of impending brain herniation.
To diagnose an epidural hematoma, a CT scan stands as the most appropriate imaging modality. On the CT scan, the hematoma will display as a lens-shaped or biconvex hyperdensity. While an epidural hematoma can traverse the midline, it will not cross suture lines. Given the potentially critical nature of this condition, an immediate neurosurgical consultation is imperative. Management options include intracranial pressure monitoring, craniotomy, or ligation of the bleeding artery to prevent further hemorrhage.
Lesson Outline
Don't stop here!
Get access to 15 more Neurology lessons & 13 more medical school learning courses with one subscription!
FAQs
An epidural hematoma is a condition where arterial blood collects between the dura and skull, often as a consequence of middle meningeal artery damage from a temporal bone fracture. This represents a medical emergency due to the potential for rapid neurological decline.
The classical presentation involves an initial loss of consciousness, followed by a lucid period that may last for hours. This is typically followed by a rapid neurologic decline. However, the clinical presentation can vary widely and include symptoms such as headache, nausea and vomiting, confusion, focal neurological deficits (such as hemiplegia, hemisensory deficits, and aphasia), seizure, and coma.
Cushing's triad, which includes symptoms of irregular breathing, bradycardia, and hypertension, indicates an acute increase in ICP. A "blown pupil" or anisocoria, which is characterized by an ipsilateral, fixed and dilated pupil, is a sign of impending herniation and signals a potentially severe progression of the condition.
A CT scan is the most appropriate first-line test in suspected cases of epidural hematoma. This is due to its ability to clearly display the characteristic imaging appearance of an epidural hematoma, which typically appears as a lens-shaped, biconvex hyperdensity. An important characteristic of epidural hematoma is that on imaging, it can cross the midline but cannot cross suture lines.
A neurosurgical consultation is needed immediately in the event of an epidural hematoma. Management may involve intracranial pressure (ICP) monitoring, craniotomy, and ligation of the bleeding artery.
MCAT® is a registered trademark of the Association of American Medical Colleges. The United States Medical Licensing Examination (USMLE®) is a joint program of the Federation of State Medical Boards (FSMB®) and National Board of Medical Examiners (NBME®). NAPLEX® is a registered trademark of the National Association of Boards of Pharmacy. PANCE© is a registered trademark of the National Commission on Certification of Physician Assistants. NCLEX® is a registered trademark and service mark of the National Council of State Boards of Nursing, Inc. None of the trademark holders are endorsed by nor affiliated with Sketchy or this website.
