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Epidural Hematoma

Epidural Hematoma is a topic covered in the 5-Minute Emergency Consult.

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Emergency Central

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Basics

Description

  • Direct skull trauma
  • Inward bending of calvarium causes bleeding when dura separates from skull:
    • Middle meningeal artery is involved in bleed >50% of time.
    • Meningeal vein is involved in 1/3.
  • Skull fracture is associated in 75% of cases, less commonly in children.
  • >50% have epidural hematoma (EDH) as isolated head injury:
    • Most commonly associated with subdural hematoma (SDH) and cerebral contusion
  • Classic CT finding is lenticular, unilateral convexity, usually in temporal region.
  • It usually does not cross suture lines, but may cross midline.

Etiology

  • Accounts for 1.5% of traumatic brain injury (TBI)
  • Male/female incidence is 3:1.
  • Peak incidence is 2nd–3rd decade of life.
  • Motor vehicle accidents (MVAs), assault, and falls are most common causes:
    • Of all blunt mechanisms, assault has highest association with intracranial injury requiring neurosurgical intervention.
  • Uncommon in very young (<5 yr) or elderly patients
  • Mortality is 12% and is related to preoperative condition.

Pediatric Considerations
  • Head injury is the most common cause of death and acquired disability in childhood.
  • Falls, pedestrian-struck bicycle accidents are most common causes:
    • Most severe head injuries in children are from MVA.
    • Always consider possibility of nonaccidental trauma.
  • <50% have altered level of consciousness (LOC):
    • If EDH in differential diagnosis (DD), CT should be obtained.
  • Bleeding is more likely to be venous.
  • Good outcome in 95% of children <5 yr

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Citation

Rosen, Peter, et al., editors. "Epidural Hematoma." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307019/all/Epidural_Hematoma.
Epidural Hematoma. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307019/all/Epidural_Hematoma. Accessed April 23, 2019.
Epidural Hematoma. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307019/all/Epidural_Hematoma
Epidural Hematoma [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307019/all/Epidural_Hematoma.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Epidural Hematoma ID - 307019 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307019/all/Epidural_Hematoma PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -