Describe the traumatic EDH.
Head injury (most common; e.g., due to motor vehicle accidents, falls, assault)
Traumatic removal of epidural catheter (especially in patients taking on anticoagulation medication)
Describe the nontraumatic EDH.
Infections
Coagulopathies
Dural vascular malformation
Dural metastases
Describe the arterial EDH.
Source: middle meningeal artery rupture or tear (a branch of the maxillary artery and the most common source of hemorrhage in EDH)
Sites of rupture
Pterion (most common): the thinnest part of the skull and a site at which the middle meningeal artery lies in close proximity to the skull
Skull base (foramen spinosum)
Describe the venous EDH.
(rare)
Source
Middle meningeal vein rupture or tear
Dural venous sinus injury
Rupture of a dural vascular malformation
Sites of rupture [7]
Posterior fossa (injury to the transverse sinus, sigmoid sinus, or confluence of venous sinuses)
Middle cranial fossa (sphenoparietal sinus injury)
Vertex (superior sagittal sinus injury)
Describe the pathophysiology.
Head trauma (usually severe) → skull fracture → rupture of middle meningeal artery (most common) → hemorrhage into the epidural space, typically in the temporal or temporoparietal region [2][9]
Venous shunting of blood out from the epidural space and initial asymptomatic compression of the anterior temporal lobe → lucid interval [2][10]
Continued expansion of EDH → increased intracranial pressure → transtentorial uncal herniation (Monro-Kellie principle) which leads to: [2]
Compression of the ipsilateral oculomotor nerve and loss of parasympathetic supply to the pupillary sphincter → ipsilateral dilated pupil (anisocoria)
Compression of the brain stem → rapid neurological decline, Cushing triad, and either of the following:
Compression of ipsilateral cerebral peduncle (more common) → contralateral hemiparesis
Compression of the contralateral cerebral peduncle against the contralateral tentorial edge (less common) → ipsilateral hemiparesis (false localizing sign known as Kernohan syndrome)
Unrelieved brain stem compression → coma and death
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