Pediatric Epidural Hematoma

  • Etiology:
    — Traumatic coup injury with tearing of middle meningeal artery or diploic veins or dural sinus results in blood between inner skull and outer dura
    — In children are more likely to be venous in origin
  • Imaging:
    — Biconvex shape
    — Does not cross suture because it is bound by the dura
    — Crosses tentorium and falx
    — Skull fracture in only 40% due to pliancy of skull
  • Note:
    — Can occur infratentorial as well as supratentorial
    — In anticoagulated patients hematomas do not become hyperdense on CT as quickly as in normal patients
  • Note: Epidural hematoma and cephalohematoma are mirror images in that epidural hematoma occurs inside skull and is bound by the dura and does not cross sutures and cepahlohematoma occurs outside skull and is bound by periosteum and does not cross sutures
  • DDX: Subdural hematoma has crescent shape and is not usually associated with a skull fracture
  • Complications:
  • Treatment: Managed expectantly based on symptoms
  • Clinical: Classically associated with lucid interval between injury and onset of symptoms

Radiology Cases of Epidural Hematoma

CT of subgaleal hematoma
Axial CT without contrast of the brain shows a high density fluid collection in the left frontal subcutaneous tissue. There is also an underlying lentiform mixed density intracranial fluid collection.
CT of epidural hematoma
Axial CT without contrast of the brain shows a right frontal high density biconvex intracranial extra-axial fluid collection.
CT of epidural hematoma
Axial CT without contrast of the brain shows a mixed density biconvex intracranial extra-axial fluid collection posterior to the left cerebellum.