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Introduction

In most cases the haemorrhage is the result of rupture of the middle meningeal artery, which is a branch of the maxillary artery (It is very important to remember: the source of bleeding is arterial)
A fracture overlies the hematoma in nearly 95% of adults
Most common sites for epidural hematomas are the temporal region followed by the frontal area
A typical clinical scenario includes transient loss of consciousness followed by recovery (lucid interval) and then subsequently followed by rapid deterioration due to hematoma expansion
CT shows biconvex hyperdense collection of blood that DOES NOT cross the suture lines

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Epidemiology

An epidural hematoma is a collection of blood within the space between dura mater and the skull. It is confined by the lateral sutures ( the coronal sutures)
It is a life-threatening condition that may require immediate intervention and can be associated with significant morbidity and mortality if left untreated
Rapid diagnosis and evacuation are important for a good outcome

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An epidural hematoma may occur as a result of severe head injury. It will begin as only a transient loss of consciousness and in approximately one-quarter of the cases there has been no initial loss of consciousness
Headache is the initial symptom in a patient who has not lost consciousness or who has regained consciousness. It is usually followed by vomiting
Focal neurological signs include dilation of the pupil secondary to 3rd cranial nerve palsy

	Extradural hemorrhage	Subdural hemorrhage	Subarachnoid hemorrhage
Location	Between the skull bone and the dura mater	between the dura and the arachnoid mater	Between the arachnoid and pia mater
Pathophysiology	Rupture of middle meningeal artery on the temporal surface of the skull	rupture of bridging cranial veins	Rupture of a berry aneurysm
Clinical presentation	history of trauma Skull fracture Lucid interval, followed by unconsciousness	History of trauma Older patients Alcohol misuse Child, non-accidental injury Gradual deterioration	History of trauma Rupture of berry aneurysm Thunderclap headache Sudden onset of symptoms
CT findings	Convex shaped	Concave/crescent	Hyper-attenuation around the circle of Willis

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CT scan is the radiological investigation of choice
CT scan will show hyperdense (white) biconvex hematoma that does not cross the sutures

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Treatment of epidural hematoma is urgent craniotomy with evacuation of the blood
It is a surgical emergency which will result in death if not removed promptly

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If the initial head injury has resulted only in a transient loss of consciousness, the patient should make full recovery following the evacuation of the hematoma
Early evacuation of the hematoma prevents permanent neurological disability

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