Epidural Hematoma (EDH)

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FACTS

  • typically biconvex (lentiform) shaped, sharply demarcated
  • usually these hematomas are beneath squamous temporal bone
notion image
  • Demographics:
    • Males > females
    • young adults
  • Etiology of bleed: usually arterial middle meningeal artery bleed (alternatively, middle meningeal vein, dural sinus). recall that MMA enters skull through foramen spinosum

HPI

  • “talk and deterioriate” history, etiologies
    • hyponatremia
    • hypoxia
    • hepatic encephalopathy
    • hypoglycemia
    • adrenal insufficiency
    • drugs / etoh withdrawal

PHYSICAL EXAM

universal exam

IMAGING

  • bleeds will look more “crescent” shaped and respect suture lines
A/P
  • be extra careful with posterior fossa EDH → can crowd the foramen magnum rapidly
  • if volume > 30 cm3, needs evacuation regardless of GCS