0:01

I did wanna show this pair of slides.

0:05

Because it highlights two of the factors

0:08

associated with epidural hematomas.

0:10

You notice that this collection stops

0:14

abruptly right at the arrow, and that is at the suture.

0:19

So this is definitely an epidural hematoma

0:21

because it's confined by the suture.

0:24

It's got somewhat of a heterogeneous

0:26

density, and that's probably 'cause of what

0:28

we call the swirl sign—that it's continuing

0:30

to bleed from the middle meningeal artery.

0:33

You might ask, what's this?

0:34

A is an arachnoid cyst.

0:36

So this patient had an epidural

0:39

hematoma, confined by the suture, that was

0:42

adjacent to a congenital arachnoid cyst.

0:45

A little curiosity.

0:47

The second case on the left that I wanted to show

0:50

was this case of an epidural hematoma secondary to

0:55

involvement of the superior sagittal sinus.

0:58

So although I showed two cases of epidural hematomas

1:02

from transverse sinus injury, it is more common to have

1:07

a fracture and disruption of the superior sagittal sinus

1:13

to cause an epidural hematoma than the transverse sinus.

1:17

So once again, superior sagittal sinus

1:20

injury leading to an epidural hematoma

1:23

is more common than transverse sinus

1:26

injury leading to an epidural hematoma.

1:30

The next slide talks about non-surgical management.

1:35

So an epidural hematoma that's less than 30 ccs,

1:38

that's less than 15 millimeters in thickness,

1:41

and has less than five millimeters in midline shift,

1:45

and has a favorable Glasgow Coma

1:47

Scale score, is one that you will see

1:49

serial CT scanning for—watching it to see whether it

1:53

enlarges or not before they go to surgical intervention.

Epidural Hematomas, Continued

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