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Epidural intracranial hematoma
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Epidural intracranial hematoma

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Contributors: James E. Towner MD, Richard L. Barbano MD, PhD
Other Resources UpToDate PubMed

Synopsis

An intracranial epidural hematoma (EDH) occurs when blood accumulates between the dura and inner table of the calvarium. The classic etiology of the bleed is traumatic injury to the middle meningeal artery following a skull fracture. The source of bleeding is arterial in 85% of cases; in 15% of cases, the etiology is venous from a meningeal vein or dural venous sinus injury. As blood accumulates in the space between the outer layer of dura and skull, it strips the dura and forms a biconvex (lenticular or football-shaped) hematoma. The dura is very adherent to the overlying cranial sutures, so the hematoma is often limited. It is more commonly seen in children and adults, whose dura is less adherent to the inner table of the skull, as opposed to infants < 2 years of age or the elderly.

The classic presentation involves a brief post-traumatic loss of consciousness, then several minutes to hours of a lucid interval, followed by obtundation and focal neurologic deficits. While this classic clinical description is widely taught, it is seen in < 20% of cases. Other less specific signs and symptoms include headache, nausea and emesis, seizures, neurologic deficits (contralateral weakness, hyperreflexia), papilledema, pupil-involving third-nerve palsy, somnolence, or coma.

Codes

ICD10CM:
S06.4X0A – Epidural hemorrhage without loss of consciousness, initial encounter
S06.4X0S – Epidural hemorrhage without loss of consciousness, sequela
S06.4X9A  – Epidural hemorrhage with loss of consciousness of unspecified duration, initial encounter

SNOMEDCT:
428268007 – Extradural intracranial hematoma

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Subdural hematoma
  • Diffuse axonal injury
  • Intracerebral hemorrhage
  • Subarachnoid hemorrhage
  • Concussion
  • Postictal state
  • Metabolic, infectious, or pharmacologic etiology for altered mental status
  • Kernohan notch phenomenon (contralateral cerebral peduncle compressed against tentorial notch) may lead to falsely localizing, ipsilateral neurologic deficits.
  • Do not fail to recognize other radiographically visible intracranial injuries, including contrecoup intracranial injuries.
  • It is important to evaluate for additional traumatic injuries, especially cervical spine injury.

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 08/23/2017
Last Updated: 03/13/2018
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Epidural intracranial hematoma
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Epidural intracranial hematoma (Early) : Drowsiness
Imaging Studies image of Epidural intracranial hematoma
Axial CT image demonstrates a hyperattenuating extra-axial collection in the left frontal region. In this post-traumatic patient, findings consistent with epidural hematoma.
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