On what do features of EDH depend?
The features of EDH depend on the size and location of the hematoma. The majority of patients have an associated skull fracture.
Describe the 3 classical signs of the classical presentation.
Classic presentation of EDH
Initial loss of consciousness immediately following a head injury
Temporary recovery of consciousness with return to normal or near-normal neurological function (lucid interval): in 20–50% of patients with EDH
Renewed decline in neurological status and onset of symptoms caused by hematoma expansion and mass effect
Describe the renewed decline in neurological status in more detail.
Contralateral focal neurological deficits
Signs of ↑ ICP (e.g., headache, Cushing triad)
Pupillary abnormalities (sign of uncal herniation)
Anisocoria with ipsilateral mydriasis (most common)
Unilateral or bilateral fixed dilated pupils
Potentially contralateral or bilateral mydriasis
Signs of cerebral herniation syndromes
Coma, death
What are other features?
Signs of associated skull fractures (e.g., scalp hematoma, liquorrhea, CSF rhinorrhea, otorrhea, Battle sign, raccoon eyes)
What should be remembered?
A lucid interval is seen in up to 50% of patients with EDH.
The majority (70–95%) of patients with EDH have an associated skull fracture.
Neurological decline following a lucid interval can be rapid (“talk and deteriorate”) and fatal without urgent intervention.
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