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MedPix™ 7363: Acute Epidural Hematoma - Medical Image Database and Atlas

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TOPIC and DISCUSSION

More Like This ? Acute Epidural Hematoma
Topic 7363 - Created: 2006-10-09 08:52:07-04 - Modified: 2009-03-21 18:13:19-04
ACR Index: 1.4
The epidural space, between the inner table of the skull and the dura, is involved in 1-4% of patients imaged for cranial trauma. 90% of cases are due to fractures of the temporal bone interrupting the middle meningeal artery (60-90%) or venous sinus (10-40%). They are usually biconvex, due to the firm adherence of the dura to the inner table. While epidural hematomas cross dural attachments, they don’t cross sutures. A “lucid interval” is described in 50% of patients, in which deterioration is delayed after the initial injury (as opposed to DAI, in which the patients are often comatose immediately following the injury).

Complications include fistula formation bridging arterial and venous structures, as well as pseudoaneurysms of the artery.

Venous epidurals are more common in the pediatric population, carry a lower incidence of skull fracture (due to the greater elasticity of the skull), but are concerning for non-accidental trauma.

Even in the acute setting, the mass may have areas of hypodensity, thought to represent serum extruded from the clot.

Chronic epidurals are occasional observed, can be concave, and must be distinguished from infection, tumor, and subdural lesions such as empyemas.

Contributor Credits

Submitted by: Joel McFarland - Author Info
Affiliation: National Naval Medical Center Bethesda
Approved By: Sharon Seltzer - Editor Info
Affiliation: Walter Reed Army Medical Center

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