Traumatic Intracranial Hemorrhage

Occurs in 1% to 4% of imaged head trauma patients

Seen in 5% to 15% of patients with fatal head injuries

Age range 20 to 40 years

Male predilection

Etiology: Head trauma with skull fracture:

• >90% of epidural hematomas are due to skull fracture traversing arterial groove of inner periosteum with rupture/laceration of an artery (usually the middle meningeal artery)

• Venous hematomas (<10%) are due to occipital, parietal, or sphenoid fractures

Most common clinical symptoms:

• Headache, nausea, vomiting, seizures, and focal neurologic deficits

• May eventually develop herniation or mass effect

• Cranial nerve 3 palsy, somnolence, decreased consciousness, and coma

May have lucid interval: initial brief loss of consciousness followed by an asymptomatic period between injury and loss of consciousness

Immediate surgical evacuation for threatening cases

Delayed treatment associated with poor outcome

Small epidural hematomas can be clinically followed with imaging

5% overall mortality

15% to 20% mortality rate with bilateral epidural hematomas

26% mortality rate for epidural hematomas located in the posterior fossa