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Acute Epidural Hematomas

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Once again, I'd like to refer to Youmans' Neurological

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Surgery textbook as one of the classic textbooks

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in neurosurgery for the indications for surgery

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when patients have acute epidural hematomas.

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And this is what is listed in the textbook.

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An epidural hematoma greater than 30 cc's.

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So once again, we measure the AP, transverse, and

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superior-inferior diameter of the collection, divided by 2.

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If it's greater than 30 cc's, that's

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one of the indications for surgery.

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If it's less than 30 cc's, but it is still greater

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than 15 millimeters in transverse thickness,

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or is associated with greater than 5 millimeters of

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midline shift, generally at the level of the septum pellucidum,

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or if the patient has an unfavorable Glasgow

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Coma Scale, those two are patients that will go on

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to removal and surgery for their epidural hematoma.

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Here's one that we would measure from

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transverse dimension, and you would see

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that this measures about 20 millimeters.

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This, by and large, by virtue of its thickness,

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would be one that would be a surgical candidate.

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This patient has contrecoup injury opposite the fracture,

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epidural hematoma with an intraparenchymal hematoma.

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So, EDH—epidural hematoma—and IPH—

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intraparenchymal hematoma, coup, contrecoup injury.

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Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Trauma

Neuroradiology

Emergency

CT

Brain

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