✔️ 1–5% of all patients with craniocerebral trauma
✔️ In 5% bilateral
✔️ usually traumatic bleeding between the inner table and dura mater •
✔️ Usually the result of arterial injury (middle meningeal artery in 85% of all cases) •
✔️ Venous bleeding occurs in 15% of all cases (diploic veins, dural venous sinus, especially in infratentorial hematomas)
✔️ May occur in combination with other forms of hematoma (subdural, subarachnoid, intracerebral) in up to 20% of all cases •
✔️ Localization: usually temporoparietal.
✔️ Imaging Modality of choice CT.
✔️ CT findings:
〰Semiconvex shape
〰Hyperdense
〰Acute, uncoagulated blood components can also be hypodense
〰The hematoma cannot cross suture lines as the dura mater is firmly attached to the bone along the boundaries of the calvaria
〰Significant mass effect: midline displacement
〰Reduced demarcation between gray and white matter
〰Obstructed flow of CSF (blockage of the interventricular foramen of Monro)
〰Cisterna ambiens narrowed
✔️ The hematoma can rapidly expand
✔️ Usually there is a displaced calvarial fracture
✔️ Postoperative contralateral rebleeding (epidural or intracerebral) may occur in response to removal of the tamponade.
✔️ MRI not indicated because of the long time required to organize and perform the examination.
✔️ Absolute emergency that can rapidly become life threatening
✔️ The patient’s condition can dramatically worsen very rapidly
✔️ Anisocoria or suddenly fixed pupils are an alarm signal but a late sign . Patients are often intubated.
✔️ Unconscious patients with an epidural hematoma not requiring surgery should have a follow-up CT within six hours
✔️ With early craniotomy, the prognosis is good; otherwise mortality is high.
✔️ The clinician should look for : Extent • Midline displacement • Obstructed flow of CSF.
#edh , #tbi , #craniotomy , #neurosurgery , #anesthesiology ,#NeuroAnesthesia ,#CTbrain
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