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side by side comparison

Epidural vs Subdural Hematoma: Arterial vs Venous Bleed — Timing Changes Everything

A patient talks to you after head trauma, then loses consciousness 30 minutes later — that lucid interval screams epidural and demands emergency craniotomy. Confuse it with the slow venous ooze of a subdural and you miss the window to save a life.

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Comparison

Side-by-side2 compared
Focus
Dimension
Epidural Hematoma
Subdural Hematoma
Pathophysiology & risk
  • Middle meningeal artery — arterial bleed
  • Young adults
  • Temporal bone fracture
  • Bridging veins — venous bleed
  • Older adults, anticoagulants, alcohol
Signs & symptoms
  • ★Lucid interval then rapid decline (hrs)
  • 'Talk and die' presentation
  • Progressive headache, confusion over days
  • Personality changes
Diagnostics & imaging
  • ★CT: biconvex / lens-shaped
  • Does NOT cross suture lines
  • ★CT: crescent-shaped
  • Crosses suture lines
Nursing priorities
  • Anticipate rapid ↑ ICP, herniation risk
  • Frequent neuro checks
  • Prep for emergent OR
  • Trend slow ↑ ICP over hours–days
  • Frequent neuro checks
  • Watch for gradual ↓ LOC
Surgical management
  • Emergent craniotomy — minutes matter
  • Acute: urgent burr holes or craniotomy
  • Chronic: elective burr-hole drainage
Teaching & prevention
  • Feeling fine after injury ≠ safe
  • Fall prevention
  • Review anticoagulant safety
  • Report confusion days–weeks after a fall
Red flags — herniation
  • Ipsilateral fixed dilated pupil
  • Contralateral hemiparesis
  • Cushing triad
  • Gradual ↓ LOC over days
  • Ipsilateral fixed dilated pupil
  • Contralateral hemiparesis
  • Cushing triad
Prognosis & complications
  • Good outcome if evacuated early
  • Chronic: often good outcomes
  • Acute in elderly: mortality 50–80%
Pathophysiology & risk

Epidural Hematoma

  • Middle meningeal artery — arterial bleed
  • Young adults
  • Temporal bone fracture

Subdural Hematoma

  • Bridging veins — venous bleed
  • Older adults, anticoagulants, alcohol
Signs & symptoms

Epidural Hematoma

  • ★Lucid interval then rapid decline (hrs)
  • 'Talk and die' presentation

Subdural Hematoma

  • Progressive headache, confusion over days
  • Personality changes
Diagnostics & imaging

Epidural Hematoma

  • ★CT: biconvex / lens-shaped
  • Does NOT cross suture lines

Subdural Hematoma

  • ★CT: crescent-shaped
  • Crosses suture lines
Nursing priorities

Epidural Hematoma

  • Anticipate rapid ↑ ICP, herniation risk
  • Frequent neuro checks
  • Prep for emergent OR

Subdural Hematoma

  • Trend slow ↑ ICP over hours–days
  • Frequent neuro checks
  • Watch for gradual ↓ LOC
Surgical management

Epidural Hematoma

  • Emergent craniotomy — minutes matter

Subdural Hematoma

  • Acute: urgent burr holes or craniotomy
  • Chronic: elective burr-hole drainage
Teaching & prevention

Epidural Hematoma

  • Feeling fine after injury ≠ safe

Subdural Hematoma

  • Fall prevention
  • Review anticoagulant safety
  • Report confusion days–weeks after a fall
Red flags — herniation

Epidural Hematoma

  • Ipsilateral fixed dilated pupil
  • Contralateral hemiparesis
  • Cushing triad

Subdural Hematoma

  • Gradual ↓ LOC over days
  • Ipsilateral fixed dilated pupil
  • Contralateral hemiparesis
  • Cushing triad
Prognosis & complications

Epidural Hematoma

  • Good outcome if evacuated early

Subdural Hematoma

  • Chronic: often good outcomes
  • Acute in elderly: mortality 50–80%

★ marks the fact that sets a column apart.

Clinical Pearl

Lucid interval then crash = epidural (artery, lens on CT); slow drift = subdural (vein, crescent on CT).

Component Topics

Epidural HematomaSubdural Hematoma

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