Epidural Hematoma
Basics
Description
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
Etiology
- Accounts for 1.5% of traumatic brain injury (TBI)
- Male/female incidence is 3:1
- Peak incidence is from second to third decades 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 10% for adults, lower for children and is related to preoperative condition
- Worse prognosis for low presenting GCS score, abnormal pupil, older patients, increased ICP preoperatively, midline shift >10 mm on CT, mixed density lesion, presence of concomitant intracranial lesion, volume of bleed >30 cc
Pediatric Considerations
- Head injury is the most common cause of death and acquired disability in childhood
- PECARN rules may be used to help stratify risk:
- Children with one of the following variables are at low risk and do not require head CT:
- LOC ≥5 s
- Vomiting (in age ≥2)
- Severe headache (in age ≥2)
- Acting abnormally to parents
- Severe mechanism
- Abnormal mental status
- Skull fracture
- GCS <15
- Scalp hematoma; nonfrontal
- Children with one of the following variables are at low risk and do not require head CT:
- 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
Schaider, Jeffrey J., et al., editors. "Epidural Hematoma." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307019/all/Epidural_Hematoma.
Epidural Hematoma. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307019/all/Epidural_Hematoma. Accessed October 7, 2024.
Epidural Hematoma. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307019/all/Epidural_Hematoma
Epidural Hematoma [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 October 07]. 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
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