18-year-old male is mugged and hit on the head with a blunt object. He loses consciousness for approximately 10 minutes, at which time, he wakes up and walks home. He is fully conscious for 20 minutes but then gradually becomes lethargic. Where is the likely site of his associated skull fracture?
Basilar region
Frontal region
Occipital region
Parietal region
Temporal region
Correct answer
Temporal region
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correct answer: E
An epidural hematoma is almost always due to a rupture of the middle meningial artery. When the skull is fractured (almost always the temporal bone), the middle meningeal artery is torn and bleeds into the epidural space. These injuries tend to present with a loss of consciousness followed by a lucid interval of a few minutes to a few hours with subsequent rapid neurologic deterioration due to continued hemorrhage and brain compression. Treatment is almost always neurosurgery to evacuate the hematoma.