Epidural Hematoma in Emergency Medicine Clinical Presentation

Updated: Oct 27, 2016
  • Author: Daniel D Price, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Presentation

History

Fewer than 20% of patients demonstrate the classic presentation of a lucid interval between the initial trauma and subsequent neurological deterioration. See the image below.

Brain CT scan of 90-year-old man who slipped on a Brain CT scan of 90-year-old man who slipped on a waxed floor. Witnesses reported loss of consciousness followed by a "lucid interval." Patient arrived to ED unconscious. CT scan indicates epidural hematoma. Image courtesy of Dr Dana Stearns, Massachusetts General Hospital.

Following injury, the patient may or may not lose consciousness. If he or she becomes unconscious, the patient may awaken or remain unconscious.

Other symptoms include the following:

  • Severe headache
  • Vomiting
  • Seizure

Patients with posterior fossa epidural hematoma (EDH) may have a dramatic delayed deterioration. The patient can be conscious and talking and a minute later apneic, comatose, and minutes from death.

Next:

Physical

Cushing response, consisting of the following, can indicate increased ICP:

  • Hypertension
  • Bradycardia
  • Bradypnea

Level of consciousness may be decreased, with decreased or fluctuating GCS.

Contusion, laceration, or bony step-off may be observed in the area of injury.

Dilated, sluggish, or fixed pupil(s), bilateral or ipsilateral to injury, suggest increased ICP or herniation.

The classic triad indicating transtentorial herniation consists of the following:

  • Coma
  • Fixed and dilated pupil(s)
  • Decerebrate posturing

Hemiplegia contralateral to injury with herniation may be observed.

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