Epidural Hematoma

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

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Emergency Central

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  • 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.


  • 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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