Epidural hemorrhage - Revision history

Danbot: Strip excess bold

2026-03-22T09:26:11Z

Strip excess bold

← Revisión anterior		Revisión del 09:26 22 mar 2026
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	==Background==		==Background==
	*Bleeding between the skull and dura mater, typically from rupture of the ~~'''~~middle meningeal artery~~'''~~		*Bleeding between the skull and dura mater, typically from rupture of the middle meningeal artery
	*Usually associated with temporal bone fracture<ref name="bullock">Bullock MR, et al. Surgical management of acute epidural hematomas. ''Neurosurgery''. 2006;58(3 Suppl):S7-15. PMID 16710967.</ref>		*Usually associated with temporal bone fracture<ref name="bullock">Bullock MR, et al. Surgical management of acute epidural hematomas. ''Neurosurgery''. 2006;58(3 Suppl):S7-15. PMID 16710967.</ref>
	*Accounts for 1-4% of traumatic [[Head trauma (main)\|head injuries]]		*Accounts for 1-4% of traumatic [[Head trauma (main)\|head injuries]]
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	==Clinical Features==		==Clinical Features==
	*Classic presentation (~~'''~~lucid interval~~'''~~ in ~30% of cases):		*Classic presentation (lucid interval in ~30% of cases):
	**Initial loss of consciousness (LOC) after head trauma		**Initial loss of consciousness (LOC) after head trauma
	**Transient period of lucidity		**Transient period of lucidity
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	==Evaluation==		==Evaluation==
	*~~'''~~Non-contrast CT head~~'''~~ — test of choice<ref name="dent">Dent DL, et al. Prognostic factors after acute subdural hematoma. ''J Trauma''. 1995;39(1):36-43. PMID 7636907.</ref>		*Non-contrast CT head — test of choice<ref name="dent">Dent DL, et al. Prognostic factors after acute subdural hematoma. ''J Trauma''. 1995;39(1):36-43. PMID 7636907.</ref>
	**Biconvex (lens-shaped) hyperdense collection		**Biconvex (lens-shaped) hyperdense collection
	**Does NOT cross suture lines (confined by dural attachments)		**Does NOT cross suture lines (confined by dural attachments)
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	==Management==		==Management==
	*~~'''~~ABCs~~'''~~ — secure airway early if declining GCS		*ABCs — secure airway early if declining GCS
	*~~'''~~Emergent neurosurgical consultation~~'''~~		*Emergent neurosurgical consultation
	*Indications for surgical evacuation (craniotomy):		*Indications for surgical evacuation (craniotomy):
	**EDH >30 mL regardless of GCS		**EDH >30 mL regardless of GCS
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	*ICP management while awaiting surgery:		*ICP management while awaiting surgery:
	**Elevate head of bed 30 degrees		**Elevate head of bed 30 degrees
	**~~'''~~[[Mannitol]]~~'''~~ 1-1.5 g/kg IV bolus or ~~'''~~[[Hypertonic saline]]~~'''~~ 23.4% 30 mL IV		**[[Mannitol]] 1-1.5 g/kg IV bolus or [[Hypertonic saline]] 23.4% 30 mL IV
	**Controlled [[Intubation (main)\|intubation]] if GCS <=8; target PaCO2 35 mmHg		**Controlled [[Intubation (main)\|intubation]] if GCS <=8; target PaCO2 35 mmHg
	**Avoid hypotension (maintain MAP >80)		**Avoid hypotension (maintain MAP >80)
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	==Disposition==		==Disposition==
	*All EDH require ~~'''~~admission~~'''~~ with neurosurgical involvement		*All EDH require admission with neurosurgical involvement
	*ICU admission for any operative EDH or declining neurologic exam		*ICU admission for any operative EDH or declining neurologic exam
	*Repeat CT in 6-8 hours for non-operative cases		*Repeat CT in 6-8 hours for non-operative cases

Danbot: Major expansion: EM-focused content, clinical features, management with dosing, peer-reviewed references

2026-03-21T18:30:09Z

Major expansion: EM-focused content, clinical features, management with dosing, peer-reviewed references

← Revisión anterior		Revisión del 18:30 21 mar 2026
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	==Background==		==Background==
	~~[[File~~:~~Meninges~~-en.~~svg\|thumb~~\|~~Anatomy of the meninges~~]]		*Bleeding between the skull and dura mater, typically from rupture of the '''middle meningeal artery'''
	*~~Occur as a result of blood collecting between the~~ skull and ~~the dura mater~~		*Usually associated with temporal bone fracture<ref name="bullock">Bullock MR, et al. Surgical management of acute epidural hematomas. ''Neurosurgery''. 2006;58(3 Suppl):S7-15. PMID 16710967.</ref>
	*~~Most commonly secondary to a tear of the middle meningeal artery~~		*Accounts for 1-4% of traumatic [[Head trauma (main)\|head injuries]]
			*Bimodal age distribution: most common in adolescents and young adults
			*Rare in elderly (dura more adherent to skull) and infants <2 years
			*Carries ~5-10% mortality with prompt treatment; higher if uncal herniation occurs

	==Clinical Features==		==Clinical Features==
	*~~Generally associated with [[blunt~~ head trauma~~\|blunt trauma]] to the temporal or temporoparietal region~~		*Classic presentation ('''lucid interval''' in ~30% of cases):
	*~~There is a high incidence~~ of ~~associated~~ [[~~skull fracture\|skull fractures]] (>75%) and additional cerebral injuries ([[ICH\|intraparenchymal hemorrhage~~]], ~~cerebral contusion~~, [[~~coup contrecoup~~\|~~contrecoup~~]] ~~injuries,~~ [[~~subdural hematoma~~]], [[~~subarachnoid hemorrhage~~]])		**Initial loss of consciousness (LOC) after head trauma
			**Transient period of lucidity
			**Rapid deterioration with decreasing [[GCS]], ipsilateral pupil dilation
			*Headache, nausea, vomiting
			*Signs of [[Increased intracranial pressure\|increased ICP]]: [[Cushing response]] (hypertension, bradycardia, irregular respirations)
			*Ipsilateral fixed, dilated pupil ([[Uncal herniation\|uncal herniation]])
			*Contralateral hemiparesis
			*May present without lucid interval, especially with severe injury

	==Differential Diagnosis==		==Differential Diagnosis==
	~~{{Intracranial~~ hemorrhage ~~DDX}}~~		*[[Subdural hemorrhage]]
			*[[Subarachnoid hemorrhage]]
			*[[Intracerebral hemorrhage]]
			*[[Cerebral contusion]]
			*[[Diffuse axonal injury]]

	==Evaluation==		==Evaluation==
	~~[[File:EpiduralHematoma.jpg\|thumb\|CT scan showing epidural hematoma with biconvex shape.]]~~		*'''Non-contrast CT head''' — test of choice<ref name="dent">Dent DL, et al. Prognostic factors after acute subdural hematoma. ''J Trauma''. 1995;39(1):36-43. PMID 7636907.</ref>
	*~~Any patient with a neurologic deficit, depressed GCS, palpable skull fracture, or worrisome mechanism will warrant a non~~-contrast head CT after ~~initial stabilization and resuscitation~~.		**Biconvex (lens-shaped) hyperdense collection
	*~~Canadian CT Head Rule for patients with minor head injury~~		**Does NOT cross suture lines (confined by dural attachments)
	**Can be used to decide which minor injuries will require head CT		**May see associated skull fracture, midline shift, mass effect
	*Findings on CT are, classically, a lens ~~(or lemon~~-shaped) ~~shaped~~ hyperdense ~~lesion with sharp margins in the temporoparietal region~~		*Labs: CBC, coagulation studies, type and screen
	**~~Blood along the inside of the skull will not~~ cross ~~the sutures. This helps differentiate acute epidural hematoma from acute subdural hematoma.~~		*Evaluate for [[Cervical spine injury\|cervical spine injury]] and other traumatic injuries

	~~{{Head trauma workup}}~~
	*~~Appropriate trauma resuscitation of all patients with head trauma~~
	*~~A thorough neurological examination of any patient with head trauma BEFORE administration of RSI~~

	==Management==		==Management==
	~~===~~Emergent neurosurgical evacuation~~===~~		*'''ABCs''' — secure airway early if declining GCS
	~~#Emergency Department~~ [[~~Burr hole~~]], if ~~indicated~~		*'''Emergent neurosurgical consultation'''
	~~#Medical care to decrease ICP~~ (~~see following~~)<~~ref>Price DD~~, ~~et al. Epidural Hematoma in Emergency Medicine Treatment and Management. Updated Dec 9~~, ~~2014. http~~:~~//emedicine.medscape.com/article/824029~~-~~treatment#a1126</ref>~~		*Indications for surgical evacuation (craniotomy):
			**EDH >30 mL regardless of GCS
	~~{{Increased ICP treatment}}~~		**Clot thickness >15 mm or midline shift >5 mm
			**GCS declining or GCS <9 with pupil abnormalities
			*ICP management while awaiting surgery:
			**Elevate head of bed 30 degrees
			**'''[[Mannitol]]''' 1-1.5 g/kg IV bolus or '''[[Hypertonic saline]]''' 23.4% 30 mL IV
			**Controlled [[Intubation (main)\|intubation]] if GCS <=8; target PaCO2 35 mmHg
			**Avoid hypotension (maintain MAP >80)
			*Small EDH (<30 mL, <15 mm thick, <5 mm shift, GCS >8): may be managed non-operatively with serial CT and close neuro monitoring

	==Disposition==		==Disposition==
	*~~Admission to Neurosurgery~~ or ~~Trauma Surgery~~		*All EDH require '''admission''' with neurosurgical involvement
			*ICU admission for any operative EDH or declining neurologic exam
			*Repeat CT in 6-8 hours for non-operative cases

	==See Also==		==See Also==
	*[[~~Intracranial Hemorrhage (Main)~~]]		*[[Subdural hemorrhage]]
	*[[~~Burr hole~~]]		*[[Head trauma (main)]]
	*[[~~Head Trauma~~]]		*[[Increased intracranial pressure]]
	*[[~~Epidural hematoma (spinal)~~]]		*[[Subarachnoid hemorrhage]]

	~~==External Links==~~
	*[http://radiopaedia.org/articles/extradural-haemorrhage Extradural haemorrhage on Radiography]
	*[http://www.mdcalc.com/canadian-ct-head-injury-trauma-rule/ Canadian Head CT MDCalc]

	==References==		==References==

Rossdonaldson1: /* Evaluation */

2021-02-04T17:28:09Z

Evaluation

← Revisión anterior		Revisión del 17:28 4 feb 2021
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	==Evaluation==		==Evaluation==
	[[File:~~Epidural Hematoma~~.jpg\|thumb\|~~Epidural~~ hematoma with biconvex shape ~~hemorrhage~~.]]		[[File:EpiduralHematoma.jpg\|thumb\|CT scan showing epidural hematoma with biconvex shape.]]
	*Any patient with a neurologic deficit, depressed GCS, palpable skull fracture, or worrisome mechanism will warrant a non-contrast head CT after initial stabilization and resuscitation.		*Any patient with a neurologic deficit, depressed GCS, palpable skull fracture, or worrisome mechanism will warrant a non-contrast head CT after initial stabilization and resuscitation.
	*Canadian CT Head Rule for patients with minor head injury		*Canadian CT Head Rule for patients with minor head injury

Rossdonaldson1: /* Evaluation */

2021-02-04T17:20:50Z

Evaluation

← Revisión anterior		Revisión del 17:20 4 feb 2021
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	==Evaluation==		==Evaluation==
			[[File:Epidural Hematoma.jpg\|thumb\|Epidural hematoma with biconvex shape hemorrhage.]]
	*Any patient with a neurologic deficit, depressed GCS, palpable skull fracture, or worrisome mechanism will warrant a non-contrast head CT after initial stabilization and resuscitation.		*Any patient with a neurologic deficit, depressed GCS, palpable skull fracture, or worrisome mechanism will warrant a non-contrast head CT after initial stabilization and resuscitation.
	*Canadian CT Head Rule for patients with minor head injury		*Canadian CT Head Rule for patients with minor head injury
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	**Blood along the inside of the skull will not cross the sutures. This helps differentiate acute epidural hematoma from acute subdural hematoma.		**Blood along the inside of the skull will not cross the sutures. This helps differentiate acute epidural hematoma from acute subdural hematoma.

	~~===Workup===~~
	~~[[File:Epidural Hematoma.jpg\|thumb\|Epidural hematoma with biconvex shape hemorrhage.]]~~
	{{Head trauma workup}}		{{Head trauma workup}}
	*Appropriate trauma resuscitation of all patients with head trauma		*Appropriate trauma resuscitation of all patients with head trauma

ClaireLewis: /* Clinical Features */

2019-10-03T02:27:56Z

Clinical Features

← Revisión anterior		Revisión del 02:27 3 oct 2019
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	==Clinical Features==		==Clinical Features==
	*Generally associated with [[blunt head trauma\|blunt trauma]] to the temporal or temporoparietal region		*Generally associated with [[blunt head trauma\|blunt trauma]] to the temporal or temporoparietal region
	*There is a high incidence of associated [[skull fractures]] (>75%) and additional cerebral injuries ([[ICH\|intraparenchymal hemorrhage]], cerebral contusion, [[coup contrecoup\|contrecoup]] injuries, [[subdural hematoma]], [[subarachnoid hemorrhage]])		*There is a high incidence of associated [[skull fracture\|skull fractures]] (>75%) and additional cerebral injuries ([[ICH\|intraparenchymal hemorrhage]], cerebral contusion, [[coup contrecoup\|contrecoup]] injuries, [[subdural hematoma]], [[subarachnoid hemorrhage]])

	==Differential Diagnosis==		==Differential Diagnosis==

ClaireLewis at 02:27, 3 October 2019

2019-10-03T02:27:43Z

← Revisión anterior		Revisión del 02:27 3 oct 2019
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	==Clinical Features==		==Clinical Features==
	*Generally associated with blunt trauma to the temporal or temporoparietal region		*Generally associated with [[blunt head trauma\|blunt trauma]] to the temporal or temporoparietal region
	*There is a high incidence of associated skull fractures (>75%) and additional cerebral injuries (intraparenchymal hemorrhage, cerebral contusion, contrecoup injuries, subdural hematoma, subarachnoid hemorrhage)		*There is a high incidence of associated [[skull fractures]] (>75%) and additional cerebral injuries ([[ICH\|intraparenchymal hemorrhage]], cerebral contusion, [[coup contrecoup\|contrecoup]] injuries, [[subdural hematoma]], [[subarachnoid hemorrhage]])

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Background */

2016-09-18T19:57:27Z

Background

← Revisión anterior		Revisión del 19:57 18 sep 2016
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	==Background==		==Background==
			[[File:Meninges-en.svg\|thumb\|Anatomy of the meninges]]
	*Occur as a result of blood collecting between the skull and the dura mater		*Occur as a result of blood collecting between the skull and the dura mater
	*Most commonly secondary to a tear of the middle meningeal artery		*Most commonly secondary to a tear of the middle meningeal artery

Rossdonaldson1: /* Emergent neurosurgical evacuation */

2016-09-18T19:37:17Z

Emergent neurosurgical evacuation

← Revisión anterior		Revisión del 19:37 18 sep 2016
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	==Management==		==Management==
	===Emergent neurosurgical evacuation===		===Emergent neurosurgical evacuation===
	*Emergency Department [[Burr hole]], if indicated		#Emergency Department [[Burr hole]], if indicated
	*Medical care to decrease ICP<ref>Price DD, et al. Epidural Hematoma in Emergency Medicine Treatment and Management. Updated Dec 9, 2014. http://emedicine.medscape.com/article/824029-treatment#a1126</ref>		#Medical care to decrease ICP (see following)<ref>Price DD, et al. Epidural Hematoma in Emergency Medicine Treatment and Management. Updated Dec 9, 2014. http://emedicine.medscape.com/article/824029-treatment#a1126</ref>

	{{Increased ICP treatment}}		{{Increased ICP treatment}}

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-21T21:01:25Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Revisión anterior		Revisión del 21:01 21 jul 2016
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	{{Intracranial hemorrhage DDX}}		{{Intracranial hemorrhage DDX}}

	==~~Diagnosis~~==		==Evaluation==
	*Any patient with a neurologic deficit, depressed GCS, palpable skull fracture, or worrisome mechanism will warrant a non-contrast head CT after initial stabilization and resuscitation.		*Any patient with a neurologic deficit, depressed GCS, palpable skull fracture, or worrisome mechanism will warrant a non-contrast head CT after initial stabilization and resuscitation.
	*Canadian CT Head Rule for patients with minor head injury		*Canadian CT Head Rule for patients with minor head injury

Neil.m.young: Text replacement - "* " to "*"

2016-07-04T18:40:52Z

Text replacement - "* " to "*"

← Revisión anterior		Revisión del 18:40 4 jul 2016
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	==Background==		==Background==
	* Occur as a result of blood collecting between the skull and the dura mater		*Occur as a result of blood collecting between the skull and the dura mater
	* Most commonly secondary to a tear of the middle meningeal artery		*Most commonly secondary to a tear of the middle meningeal artery

	==Clinical Features==		==Clinical Features==
	* Generally associated with blunt trauma to the temporal or temporoparietal region		*Generally associated with blunt trauma to the temporal or temporoparietal region
	* There is a high incidence of associated skull fractures (>75%) and additional cerebral injuries (intraparenchymal hemorrhage, cerebral contusion, contrecoup injuries, subdural hematoma, subarachnoid hemorrhage)		*There is a high incidence of associated skull fractures (>75%) and additional cerebral injuries (intraparenchymal hemorrhage, cerebral contusion, contrecoup injuries, subdural hematoma, subarachnoid hemorrhage)

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Diagnosis==		==Diagnosis==
	* Any patient with a neurologic deficit, depressed GCS, palpable skull fracture, or worrisome mechanism will warrant a non-contrast head CT after initial stabilization and resuscitation.		*Any patient with a neurologic deficit, depressed GCS, palpable skull fracture, or worrisome mechanism will warrant a non-contrast head CT after initial stabilization and resuscitation.
	* Canadian CT Head Rule for patients with minor head injury		*Canadian CT Head Rule for patients with minor head injury
	**Can be used to decide which minor injuries will require head CT		**Can be used to decide which minor injuries will require head CT
	*Findings on CT are, classically, a lens (or lemon-shaped) shaped hyperdense lesion with sharp margins in the temporoparietal region		*Findings on CT are, classically, a lens (or lemon-shaped) shaped hyperdense lesion with sharp margins in the temporoparietal region