CT head of Extradural (Epidural) hematomaExtradural hematoma

imageThey arise between the inner table of the skull & the dura. They usually develop from injury to the middle meningeal artery or one of its branches, and therefore are usually temporoparietal in location. A temporal bone fracture is often the cause but is not essential. The expanding hematoma dissects the dura from the skull; this attachment is quite strong such that the hematoma is confined, giving rise to its characteristic biconvex (lenticular) shape, with a well-defined margin. It is usually of uniform (homogenous) high density but may contain hypodense foci due to active bleeding. There is often significant mass effect (midline shift) with compression of the ipsilateral lateral ventricle and dilatation of the opposite lateral ventricle due to shift of the CSF & obstruction of the foramen of Munro.
It can cross the dural reflections unlike a subdural hematoma but not suture lines where the dura tightly adheres to the adjacent skull.

imageThey arise between the dura & arachnoid matter, usually from ruptured veins crossing this potential space. This space enlarges as the brain atrophies (due to aging) and so subdural hematomas are more common in the elderly due to senile brain atrophy. Acute subdural hematomas have high attenuation (hyperdense); thisdecreases with time, becoming isodense after a week (subacute subdural hematoma) and hypodense after 2 weeks (chronic subdural hematoma).

ct Subdural hematoma
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