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Epidural Hematoma, Classic


KEY FACTS

Terminology

  • Blood collection between skull and dura

Imaging

  • NECT

    • Hyperdense, biconvex, extraaxial collection

    • > 95% unilateral, supratentorial

    • Does not cross sutures unless venous or sutural diastasis/fracture is present

    • Compresses/displaces underlying brain, subarachnoid space

    • Low-density swirl sign: Active/rapid bleeding with unretracted clot

    • 1/3-1/2 have other significant lesions

  • Bone CT

    • Skull fracture in 90-95%

Top Differential Diagnoses

  • Subdural hematoma

  • Neoplasm

  • Infection/inflammation

  • Extramedullary hematopoiesis

Pathology

  • Arterial (90-95%)

    • Arterial epidural hematoma (EDH) is most often near middle meningeal artery groove fracture

  • Venous EDH (5-10%)

    • Fracture is adjacent to dural sinus

    • Common sites: Vertex, anterior middle cranial fossa

Clinical Issues

  • Classic “lucid interval”

    • ~ 50% of cases

  • Good outcome if promptly recognized and treated

  • Some EDHs < 1 cm may be managed nonoperatively

    • Anterior middle fossa epidural hematoma is usually venous, benign

Coronal graphic illustrates swirling acute hemorrhage from a laceration of the middle meningeal artery by an overlying skull fracture. The epidural hematoma displaces the dura inward as it expands.

Axial NECT scan in a 47-year-old man with head trauma shows a classic biconvex (lentiform) uniformly hyperdense epidural hematoma (EDH)
in the right middle fossa. Bone CT (not shown) disclosed a nondisplaced skull fracture underlying the hematoma.

Coronal scan reformatted from the axial date nicely demonstrates the classic middle cranial fossa acute EDH
.

Sagittal NECT scan reformatted from the axial source date in the same patient shows that the classic biconvex configuration of the acute middle fossa EDH
is present in all 3 major imaging planes.

TERMINOLOGY

Abbreviations

  • Epidural hematoma (EDH)

Definitions

  • Blood collection between inner table of skull and outer (periosteal) layer of dura

IMAGING

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