Epidural Hematoma

An epidural hematoma (EDH) is arterial bleeding — typically from the middle meningeal artery — that collects between the skull and the dura mater after a temporal bone fracture. Because it is arterial, pressure builds fast. The hallmark presentation is a lucid interval: the client sustains a head injury, may lose consciousness briefly, then appears to recover and seems neurologically intact for minutes to hours. As the hematoma expands, intracranial pressure rises rapidly, causing sudden deterioration — worsening headache, decreasing level of consciousness, ipsilateral fixed and dilated pupil (from uncal herniation compressing CN III on the same side as the bleed), and contralateral hemiparesis. On CT scan, an EDH appears as a biconvex (lens-shaped) hyperdense collection that does not cross suture lines, because the dura is tightly adhered at sutures. This is a surgical emergency requiring emergent craniotomy for evacuation. Without intervention, brain herniation progresses to death. Nursing priority is serial neuro checks — GCS every 15-30 minutes — to catch the transition from lucid interval to rapid decline. Any decrease in GCS of 2 or more points warrants immediate provider notification.