Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Dec 18 2019

Epidural Hematoma

  • Snapshot
    • A 28-year-old man presents to the emergency department after a motor vehicle accident. The patient has a Glasgow score of 10. After airway, breathing, and circulation is secured, he undergoes a head CT without contrast, which demonstrates a lens-shaped hyperdensity that does not cross the suture line. There is a mild midline shift demonstrated on head imaging. Neurosurgery was consulted and plans are made for a craniotomy and hematoma evacuation.
  • Introduction
    • Overview
      • an epidural hematoma is a condition characterized by arterial bleeding developing in the potential space between the dura and the skull
        • treatment includes surgical decompression with a craniotomy
  • Epidemiology
    • Risk factors
      • head injury
  • Etiology
    • Middle meningeal artery tear
    • Pathoanatomy
      • the middle meningeal artery is a branch of the maxillary artery
        • serves to supply the skull and the dura
      • head injury leads to a tear in the middle meningeal artery, leading to rapid filling in the epidural space, which compresses the parenchyma of the brain
        • brain parenchymal compression can lead to transtentorial brain herniation
        • the petrosal bone is thin, which can be easily fractured, resulting in a middle meningeal artery tear
  • Presentation
    • Symptoms/physical exam
      • note that there are a spectrum of clinical presentations
      • transient loss of conciousness
      • "lucid interval"
        • characterized by recovery of the patient's conciousness, followed by clinical deterioration due to expansion of the hematoma that's under arterial pressure
          • expansion of the hematoma can result in
            • ipsilateral dilated pupil (secondary to uncal herniation)
            • Cushing reflex (e.g., hypertension, bradycardia, and respiratory depression)
  • Imaging
    • CT head without contrast
      • indication
        • imaging study of choice due to its rapidity in obtaining images and easy identification of the hematoma
      • findings
        • lens-shaped, biconvex hyperdensity that does not cross the suture lines
  • Differential
    • Subdural hematoma
      • differentiating factors
        • crescent-shaped hemorrhage seen on CT head without contrast
    • Subarachnoid hemorrhage
      • differentiating factors
        • thunderclap headache
        • hyperdensity in the subarachnoid space on CT head without contrast
  • Treatment
    • Operative
      • craniotomy and hematoma exacuation
        • indication
          • mainstay of treatment in symptomatic acute epidural hematomas
  • Complications
    • Transtentorial herniation
    • Respiratory failure and death
1 of 0
1 of 2
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options