CBL: Subdural vs Epidural Hematoma

Elderly fall with next-day headache and dressing apraxia — what’s the bleed and what’s the plan?

Topic: Neurotrauma Level: Resident Tags: subdural, epidural, CT, elderly-fall

Vignette

An 82-year-old man slips on icy leaves, bumps his head, and feels well initially. The next morning he develops a severe headache and difficulty dressing, confusing right and left sleeves. A clinic-sent noncontrast head CT reveals a crescentic hyperdense collection over the right parietal convexity—consistent with a subdural hematoma compressing parietal cortex (apraxia).

Question 1

Which CT morphology best distinguishes epidural from subdural hematoma?

  • A. Mechanism of injury
  • B. Convex (biconvex/lens) vs. concave (crescent) shape
  • C. Brightness of blood
  • D. Lobar location (frontal/parietal/temporal)

Question 2

When does a subdural hematoma most clearly require urgent neurosurgical intervention?

  • A. New or worsening impairment of consciousness or focal deficits
  • B. Diagnosis made by CT in the ED
  • C. Mechanism is a ground-level fall
  • D. Any headache after trauma

Question 3

Which statement about epidural hematoma is most accurate?

  • A. Usually venous bleeding beneath the dura
  • B. Commonly presents days after injury with gradual symptoms
  • C. Often arterial with rapid deterioration; surgical emergency
  • D. Best observed because most resolve spontaneously

Teaching Points

  • Subdural = venous bridging vein tear beneath dura → crescentic CT collection; management ranges from observation to evacuation.
  • Epidural = arterial bleed between skull and dura (often MMA) → biconvex CT collection; neurosurgical emergency.
  • Noncontrast head CT is first-line for acute traumatic headache or focal deficits.
  • Monitor closely for delayed deterioration; escalate care with declining exam or mass effect.

References

  1. Standard emergency neuroimaging reviews and neurosurgical texts on traumatic intracranial hemorrhage.