A client arrives at the ER after slipping on a patch of ice and hitting her head. A CT scan of the head shows a collection of blood between the skull and dura mater. Which type of head injury does this finding suggest?
A. Subdural hematoma
B. Subarachnoid hemorrhage
C. Epidural hematoma
D. Contusion
Correct Answer: C. Epidural hematoma
An epidural hematoma occurs when blood collects between the skull and the dura mater. An epidural hematoma (EDH) is an extra-axial collection of blood within the potential space between the outer layer of the dura mater and the inner table of the skull. It is confined by the lateral sutures (especially the coronal sutures) where the dura inserts. It is a life-threatening condition, which may require immediate intervention and can be associated with significant morbidity and mortality if left untreated. Rapid diagnosis and evacuation are important for a good outcome.
Option A: In a subdural hematoma, venous blood collects between the dura mater and the arachnoid mater. A subdural hematoma forms because of an accumulation of blood under the dura mater, one of the protective layers to the brain tissue under the calvarium. The understanding of subdural hematoma relies on the knowledge of neuroanatomical sheets covering the brain.
Option B: In a subarachnoid hemorrhage, blood collects between the pia mater and arachnoid membrane. Subarachnoid hemorrhage is defined as blood between the arachnoid membrane and the pia membrane. Several factors compromise this syndrome. Most subarachnoid hemorrhages are traumatic in nature. Aneurysmal subarachnoid hemorrhage compromises a small portion of this patient population, but nevertheless is the most worrisome type of subarachnoid hemorrhage.
Option D: A contusion is a bruise on the brain’s surface. Contusions can progress and expand, and in many cases, other hemorrhagic contusions are present. Brain contusions have been attributed to bleeding from the continuous flow of injured microvessels during the initial traumatic episode. Hemorrhagic contusions overlie brain parenchyma with loss of function.
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