Subdural hematoma vs Epidural hematoma
How to tell Subdural hematoma and Epidural hematoma apart when a board question makes them look alike.
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CT shape and suture behavior of extra-axial blood.
Side by side
Gradual or delayed neurologic decline after minor trauma in older or alcohol-use patients suggests subdural hematoma.
Head trauma followed by brief lucidity and rapid deterioration suggests epidural hematoma.
Bridging vein rupture causes venous bleeding that spreads along the dural surface.
Middle meningeal artery injury causes rapidly expanding arterial bleed between skull and dura.
Noncontrast head CT shows crescent-shaped extra-axial collection crossing suture lines, often with mixed density if subacute.
Noncontrast head CT shows biconvex lens-shaped hyperdensity limited by sutures, often with associated temporal bone fracture.
The trap
Mistaking a lucid interval for benign concussion delays neurosurgical care in epidural hematoma. Rapid re-evaluation is essential when mental status worsens after trauma.
The repair move
Next best step: secure airway and hemodynamics, obtain emergent neurosurgical consultation, and proceed to urgent hematoma evacuation for epidural bleed with mass effect; manage subdural based on neurologic status and hematoma size.
Try a free question
CoreA 78-year-old man presents days after a fall with progressive confusion and headache. CT shows crescent-shaped collection crossing suture lines. What is the most likely diagnosis?
Show answer and explanation
Answer: B. Subdural hematoma. Delayed symptoms with crescent extra-axial blood crossing sutures are classic for subdural hematoma.
Why the other choices are tempting
- A. Incorrect because epidural hematoma is lens-shaped and typically limited by sutures.
- C. Incorrect because SAH primarily fills basal cisterns and sulci, not crescent extra-axial spaces.
- D. Incorrect because intraparenchymal hemorrhage is within brain tissue rather than extra-axial crescent pattern.
- E. Incorrect because migraine does not produce traumatic extra-axial blood on CT.
Flashcards
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What CT morphology identifies epidural hematoma in trauma?
Biconvex lens-shaped extra-axial blood limited by suture lines.
What patient profile commonly presents with subdural hematoma after seemingly minor trauma?
Older adults or chronic alcohol-use patients with bridging-vein vulnerability.
Quick answers
What is the fastest way to tell Subdural hematoma from Epidural hematoma?
CT shape and suture behavior of extra-axial blood.
What is the key clue for Subdural hematoma?
Gradual or delayed neurologic decline after minor trauma in older or alcohol-use patients suggests subdural hematoma.
What is the key clue for Epidural hematoma?
Head trauma followed by brief lucidity and rapid deterioration suggests epidural hematoma.
What is the common trap with Subdural hematoma vs Epidural hematoma?
Mistaking a lucid interval for benign concussion delays neurosurgical care in epidural hematoma. Rapid re-evaluation is essential when mental status worsens after trauma.