Traumatic brain injury with epidural hematomas and skull fracture

Case contributed by Subash Thapa


Case of road traffic accident presented with headache, nausea and vomiting.

Patient Data

Age: 30 years
Gender: Male

There are two lentiform shaped supratentorial extra-axial hyperdense collections of (68-75) HU involving the right temporal (51 x12x49 mm) and the right frontal region (6x40x42 mm). They cause buckling of gray-white matter interface inward with associated mass effect as evidenced by the effacement of the ipsilateral lateral ventricle, Sylvian fissure, and the adjacent cortical sulci.

There is soft tissue swelling involving the right frontotemporal region.

There are linear fractures involving the frontal bone towards right extending to the right temporal bone and floor of the middle cranial fossa.

Case Discussion

Epidural hematomas over 90% are unilateral and supratentorial where 90-95% are found directly adjacent to the skull fracture, with the squamous portion of temporal bone being the most common site.

EDHs typically do not cross sutures (also in this case) but can cross if the fracture is with sutural diastasis.

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