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Epidural Hematoma

Last Updated: October 1, 2018

Figure 1: Harvey Cushing illustrated an epidural hematoma with an associated skull fracture (circa 1906).

An epidural hematoma (EDH) is one of the most widely known and definitively treatable of all neurologic conditions. In almost all cases, an EDH is caused by blunt trauma leading to a skull fracture. This etiology owes its prevalence to two coinciding phenomena of human evolution. First, the pterion, where the frontal, temporal, sphenoid, and parietal bones meet, is the weakest area of the entire skull and the most likely region to fracture with a traumatic insult.

Second, the middle meningeal artery courses into the skull via the foramen spinosum and proceeds superiorly to the area of the pterion. Thus, the artery and its branches are at risk for direct insult whenever the pterion is fractured.