🧠 Epidural Hematoma: The Lucid Danger of Head Trauma on the USMLE

Epidural hematoma (EDH) is a life-threatening arterial bleed between the skull and dura mater. It often results from temporal bone fractures and classically presents with a lucid interval—a favorite USMLE buzzword.

USMLE Tip: Lucid interval after head trauma = Epidural Hematoma

🧬 Pathophysiology

• Head trauma → temporal bone fracture → rupture of middle meningeal artery

• Rapid arterial bleeding → hematoma forms between skull and dura

• Increased intracranial pressure → brain herniation → death if untreated

🧪 Classic Clinical Presentation

Phase	Description
Initial loss of consciousness	Occurs immediately after trauma
Lucid interval	Patient regains consciousness and appears normal
Rapid deterioration	Headache, vomiting, altered mental status, CN III palsy

🧠 CT Imaging Findings

Feature	Description
Shape	Biconvex (lens-shaped) hyperdensity
Location	Does not cross suture lines
Midline shift	May be present in severe cases

Compare with subdural hematoma (crescent-shaped, crosses sutures).

🏥 Management Steps

Step	Action
1	Emergency craniotomy (surgical decompression)
2	Airway stabilization, monitor ICP
3	Reverse anticoagulation if applicable
4	Observation only if small, stable, asymptomatic (rare)

⚡ Time is brain — immediate surgical decompression saves lives.

📚 Sample USMLE Vignette

A 25-year-old man is hit in the temple with a baseball. He briefly loses consciousness, then wakes up and appears fine. An hour later, he becomes unresponsive. CT shows a biconvex hyperdense lesion. What’s the diagnosis?

✅ Answer: Epidural hematoma

📲 Call to Action

🧠 Don’t forget the lucid interval — it’s a USMLE classic.

📲 Download the King of the Curve App for:

• CT-based review questions

• Neuro emergencies made visual

• Daily prep challenges

• Curve Coins for confidence and consistency

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