UMEM Educational Pearls

Title: What's the Diagnosis? Case by Dr. Nicholas Santavicca and Dr. Semhar Tewelde

Posted: 5/11/2015 by Haney Mallemat, MD
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40 year-old male sustains a blunt force injury the left side of his lead. What's the diagnosis and what structure was injured?

Epidural Hematoma with mid-line shift from middle meningeal artery injury; see image below for comparison of subdural and epidural

Epidural hematoma

Blood accumulates between dura and calvarium secondary to trauma; concurrent skull fractures are common
Middle menial artery is usually involved in the temporal region; other arteries may be involved depending on which area of the skull receives the impact
Up to one-third of cases present with the "classic" lucid interval from injury and loss of consciousness to a decline in mental status. Diagnosis should be suspected, however, based on mechanism
Treatment is surgical evacuation, however aggressive medical management of increased intracranial pressure should not be delayed:
- Head of bed elevated and keep neck mid-line
- Anti-emetics and analgesics
- Osmotic agents such as mannitol or hypertonic saline
- Avoid hypoxia, hypotension, and hyperthermia

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