UMEM Educational Pearls


40 year-old male sustains a blunt force injury the left side of his lead. What's the diagnosis and what structure was injured?


Epidural Hematoma with mid-line shift from middle meningeal artery injury; see image below for comparison of subdural and epidural

Epidural hematoma

  • Blood accumulates between dura and calvarium secondary to trauma; concurrent skull fractures are common
  • Middle menial artery is usually involved in the temporal region; other arteries may be involved depending on which area of the skull receives the impact
  • Up to one-third of cases present with the "classic" lucid interval from injury and loss of consciousness to a decline in mental status. Diagnosis should be suspected, however, based on mechanism
  • Treatment is surgical evacuation, however aggressive medical management of increased intracranial pressure should not be delayed:
    • Head of bed elevated and keep neck mid-line
    • Anti-emetics and analgesics
    • Osmotic agents such as mannitol or hypertonic saline
    • Avoid hypoxia, hypotension, and hyperthermia


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