Neurology

Epidural Hematoma song

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Epidural Hematoma

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Epidural hematoma is caused by rupture of the middle meningeal artery, most commonly following a pterion fracture (temporal bone), the thinnest part of the skull.
Classic presentation: brief loss of consciousness → lucid interval → rapid neurological deterioration as the hematoma expands.
Blood accumulates between the skull and dura mater, forming a biconvex (lens-shaped) hyperdense lesion on non-contrast CT.
As the hematoma expands, uncal herniation occurs, compressing CN III → ipsilateral fixed, dilated pupil ("blown pupil") and contralateral hemiplegia (false localizing sign if Kernohan's notch).
Epidural hematoma does not cross suture lines because the dura is tightly adhered to the skull at suture margins, distinguishing it from subdural hematoma.
The majority of epidural hematomas are arterial in origin; venous epidural hematomas can occur in the posterior fossa from transverse/sigmoid sinus injury.
Urgent non-contrast CT head is the diagnostic study of choice; LP is contraindicated when herniation is suspected.
Definitive treatment is emergent surgical evacuation (craniotomy); burr hole decompression may be performed if herniation is imminent and neurosurgery is delayed.
A hematoma volume >30 mL, thickness >15 mm, or midline shift >5 mm are surgical intervention thresholds per guidelines.
Prognosis is generally favorable with prompt surgical intervention compared to subdural hematoma, due to the absence of underlying brain parenchymal injury in most cases.