Which hematoma is classically associated with arterial bleeding across a skull fracture and can present with a lucid interval?

Which hematoma is classically associated with arterial bleeding across a skull fracture and can present with a lucid interval?

• A. Epidural hematoma
• B. Subdural hematoma
• C. Subarachnoid bleed
• D. Diffuse axonal injury

Answer: (A)

Arterial bleeding across a skull fracture creates a rapidly expanding collection between the skull and the dura, often from the middle meningeal artery with a temporal bone fracture. Because arterial blood pours in quickly, intracranial pressure rises fast and neurological status can deteriorate rapidly. A lucid interval occurs when the patient briefly regains consciousness after the initial injury, only to worsen as the hematoma expands. On imaging, this hematoma is lens-shaped (biconvex) and limited by sutures, reflecting its confinement between the skull and dura. This pattern and the brisk progression are what link it to an arterial bleed after fracture and to the lucid interval. Emergent surgical evacuation is needed to stop the bleeding and relieve pressure. By contrast, a subdural hematoma involves venous bleeding and forms a crescent shape that can cross sutures and typically has a more gradual onset; a subarachnoid bleed involves blood in the subarachnoid space rather than a focal extra-dural collection; diffuse axonal injury is not a hematoma at all but a widespread brain injury from shearing forces.

Arterial bleeding across a skull fracture creates a rapidly expanding collection between the skull and the dura, often from the middle meningeal artery with a temporal bone fracture. Because arterial blood pours in quickly, intracranial pressure rises fast and neurological status can deteriorate rapidly. A lucid interval occurs when the patient briefly regains consciousness after the initial injury, only to worsen as the hematoma expands. On imaging, this hematoma is lens-shaped (biconvex) and limited by sutures, reflecting its confinement between the skull and dura. This pattern and the brisk progression are what link it to an arterial bleed after fracture and to the lucid interval. Emergent surgical evacuation is needed to stop the bleeding and relieve pressure. By contrast, a subdural hematoma involves venous bleeding and forms a crescent shape that can cross sutures and typically has a more gradual onset; a subarachnoid bleed involves blood in the subarachnoid space rather than a focal extra-dural collection; diffuse axonal injury is not a hematoma at all but a widespread brain injury from shearing forces.