A head trauma patient has a GCS of 7 after resuscitation. CT brain shows a biconvex hyperdense (lens-shaped) collection over the right temporal region with significant midline shift. What is the most likely diagnosis and immediate management?
- A Acute subdural hematoma; conservative management
- B Epidural hematoma; urgent surgical evacuation ✓
- C Intracerebral hemorrhage; craniotomy
- D Diffuse axonal injury; ICP monitoring
Correct answer: B. Epidural hematoma; urgent surgical evacuation
Explanation
A biconvex (lens-shaped or lenticular) hyperdense collection on CT brain is the hallmark of an epidural hematoma (EDH), typically caused by rupture of the middle meningeal artery following temporal bone fracture. EDH with GCS ≤8, hematoma volume >30 mL, clot thickness >15 mm, or midline shift >5 mm requires urgent surgical evacuation (craniotomy and hematoma evacuation). The 'lucid interval' — a period of consciousness followed by deterioration — is classically associated with EDH. Urgent surgery is critical as outcome is excellent if operated before herniation.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.