Question
A 30 year old patient of RTA was brought to the emergency room. There was a history of 2 episodes of vomiting. The patient was initially conscious and oriented, but after a few hours, he became drowsy and then progressed to stupor and coma. This sequence of lucid interval was followed by neurological deterioration. What is the preferred treatment option?
| A. | Observation |
| B. |
Medical management (IV mannitol) |
| C. |
Burr hole evacuation |
| D. |
Decompressive craniectomy |
|
Correct Answer � C Explanation |
 |
Epidural Hematoma
– Etiology: Trauma → middle meningeal artery rupture.
– Classical sign: lucid interval followed by rapid neurological decline.
– Rapid hematoma expansion causes mass effect & risk of brain herniation without urgent evacuation.
CT Image Interpretation:
– Shows biconvex (lentiform), hyperdense lesion in temporoparietal region—classic epidural hematoma.
– Typically does not cross sutures but displaces brain tissue.
Management:
– Neurological deterioration signals neurosurgical emergency.
– Preferred treatment: burr hole evacuation or craniotomy to relieve pressure & remove hematoma.
– Delays risk brain herniation & death.
– Prognosis: excellent if treated early.
Why Other Options Are Incorrect:
A. Observation – Only for small, asymptomatic bleeds; not for worsening epidural hematoma.
B. IV mannitol – Temporizing to reduce intracranial pressure but not definitive treatment.
D. Decompressive craniectomy – Reserved for diffuse cerebral edema or refractory raised ICP post-evacuation, not isolated epidural hematoma.