Brain (CNS)
Epidural Hematoma
경막외혈종
Arterial bleed between dura and skull from middle meningeal artery laceration after temporal fracture
- How common
- 1-3% of TBI cases
- Typical age
- Young adult trauma
What is it?
Temporal bone fracture → middle meningeal artery laceration → high-pressure arterial bleed between dura and skull → herniation risk.
Commonly affected: Temporal lobe (most common), brainstem compression
How it develops
- Temporal bone fracturePterion region impact
- MMA lacerationHigh-pressure arterial bleed
- Epidural expansionStrips dura from skull
- Lucid interval → comaCompression after dural stripping
Symptoms
- Lucid intervalRecovery then deterioration
- Ipsilateral pupil dilationCN III compression on same side
- Contralateral hemiparesisCerebral peduncle compression
- Cushing responseHTN, bradycardia, irregular respiration
- Headache/vomitingRaised ICP
How it is examined
- Serial GCSMonitor LOC changes
- Pupil examIpsilateral dilation, loss of light reflex
- Scalp examBattle sign, raccoon eye, CSF leak
Imaging
Emergent non-contrast head CT.
- Biconvex lens shape
- Does NOT cross sutures
- Associated temporal fracture
CT usually sufficient; MRI for complications.
- Dural detachment
- Parenchymal injury
Non-surgical care
- ICP controlHead elevation, mannitol, brief hyperventilation
- AntiseizureLevetiracetam
- Trauma stabilizationABC, c-spine precautions
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Emergency surgery is standard (>30 mL or thickness >15 mm or midline shift >5 mm)
Procedures that may be discussed
- Emergent craniotomy + evacuation
- MMA ligation
- Decompressive craniectomy if edema severe
Outlook
Excellent prognosis with rapid surgery (mortality <10%); delayed treatment mortality >50%.