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Traumatic Epidural Hematoma


n 18-year-old intoxicated man was assaulted with a glass bottle Gary L. Gallia, M.D., Ph.D.
on the left parietal region of his head and had a 5-minute loss of conscious- Michael H. Sobotta, M.B., B.S.
ness. The patient went home, but ICM2 hours
the injury, he presented
Johns Hopkins Hospital
local emergency department with severeREG headache,
F FIGURE nausea,
a-c and vomiting. On physi-
Baltimore, MD 21287
cal examination, his score on the Glasgow CASE Coma
TITLE Scale was 15 (scores range Revised from
3 to 15, with 15 indicating a normal level Enon
of consciousness), Linehe had 4-C equal and bi-
laterally reactive pupils, and there wasFILL a small contusion H/T on the H/T
Combo scalp in 39p6the left
temporoparietal region. Computed tomography ofAUTHOR, the head revealed
PLEASE NOTE: a 2.5-cm epi-
dural hematoma in the left parietal region (Panels
Figure has beenA and and
redrawn B) type
underlying a linear,
has been reset.
Please check carefully.
nondisplaced skull fracture (Panel C, arrows). There was mass effect, effacement of
the left ventricular system, and 6 mm ofJOB: left-to-right
36006 midline shiftISSUE:(Panel2-5-09
A, arrow).
After 30 minutes, his score on the Glasgow Coma Scale dropped to 13, and he was
intubated and transported by helicopter to our hospital, where on arrival 30 min-
utes later, his left pupil was dilated. He was taken directly to the operating room,
where he underwent a craniotomy for evacuation of the epidural hematoma. Sev-
eral bleeding sites from the middle meningeal artery were identified and coagu-
lated. He returned to work as a builder 3 months after the injury. At his last follow-
up examination, 14 months after the injury, he had no physical or cognitive
Copyright 2009 Massachusetts Medical Society.

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n engl j med 360;6 february 5, 2009 615

The New England Journal of Medicine
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Copyright 2009 Massachusetts Medical Society. All rights reserved.