Neuroradiology

Haematoma, epidural

extracerebral blood collection, located between the dura and the inner table of the skull. Usually arterial, the lesion is almost invariably post-traumatic and associated with a skull fracture and tearing of the meningeal vessels. An epidural haematoma may result from a tear of the dural sinus and then be venous in origin (Fig.1). This type of haematoma is more common in the posterior fossa and results from a tear of the transverse or sigmoid sinus.

The shape is usually biconvex and not crescentic, unlike the majority of subdural haematomas.

An epidural haematoma, frontal, occipital or at the vertex, may cross the midline; subdural haematomas do not cross the midline.

CT is the modality of choice to demonstrate the hyperdense biconvex extracerebral collection (Fig.2); with an appropriate window setting the associated skull fracture, when present, may also be demonstrated.

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Fig.1

a, b. MR, T1-weighted images in coronal and sagittal planes of a venous epidural haematoma due to tear of the superior sagittal sinus following a fracture of the parietal bone at the vertex. The haematoma crosses the midline, the dura and the sinuses are detached from the inner table and displaced downward. c. The corresponding axial CT shows the hyperdense blood collection crossing the midline at the vertex.
Haematoma, epidural, Fig.1 (a)
Haematoma, epidural, Fig.1 (b)
Haematoma, epidural, Fig.1 (c)
Haematoma, epidural, Fig.2