A patient with acute epidural hematoma on CT head shows a biconvex hyperdense lesion at the temporal region. GCS is 14 (talking), but 30 minutes later deteriorates to GCS 8. This pattern is called the 'lucid interval.' Which vessel is most commonly injured?
- A Middle cerebral artery
- B Anterior cerebral artery
- C Middle meningeal artery ✓
- D Transverse sinus
Explanation
Epidural (extradural) hematoma classically results from rupture of the middle meningeal artery following temporal bone fracture. The biconvex (lens-shaped) hyperdense collection does not cross suture lines. The lucid interval occurs because arterial bleeding initially causes a modest concussive loss of consciousness, followed by temporary recovery as the hematoma forms slowly, then rapid deterioration when the hematoma reaches critical volume and causes transtentorial herniation. EDH is a surgical emergency requiring urgent craniotomy and hematoma evacuation. The transverse sinus injury causes posterior fossa EDH, which is less common.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.