Epidural vs Subdural hematoma

[3dee]

I'm having trouble distinguishing between epidural and subdural hematomas.

"Epidural hematomas do not cross suture lines"- First aid;
"Epidural hematomas can cross dural attachments"- Neuro HY
What exactly does this mean?!?!

If it's described, I know the different key words (biconcave disk, crescent shaped ect) but I dont know how to distinguish them on CT. Ive looked at many of them trying to pick out the differences and unless the subdural hematoma is huge and theres a midline shift, I cant point out the differences!!

Please help!

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[tkim]

I'm having trouble distinguishing between epidural and subdural hematomas.

"Epidural hematomas do not cross suture lines"- First aid;
"Epidural hematomas can cross dural attachments"- Neuro HY
What exactly does this mean?!?!

If it's described, I know the different key words (biconcave disk, crescent shaped ect) but I dont know how to distinguish them on CT. Ive looked at many of them trying to pick out the differences and unless the subdural hematoma is huge and theres a midline shift, I cant point out the differences!!

Please help!

Epidural = "eye-pidural" = eye-shaped.

Subdural = "scimitar" = scimitar-shaped

 

[AndyRSC]

On the boards you'll be given a pretty clear-cut image as far as shape goes, meaning it'll be pretty damn crescent- or lens-shaped. I don't believe epidural hematomas can cross sutures, since the outer dural layer is continuous with the bone periosteum. As far as clinical differences,

Epidural hematoma – most caused by injury near pterion. Pt is completely alert during lucid phase, which is followed by depressed LOC, CN III signs (fixed, dilated, down-and-out pupil) and contralateral (some sources say ipsilateral) paresis.

Subdural hematoma – may be acute or chronic. Acute are due to major trauma and appear in minutes to days; pt barely awake during lucid period. Chronic develop over days to weeks (even months) after relatively minor trauma. Very common in elderly and alcoholics (due to cortical atrophy > larger intermeningeal gaps), and in shaken baby syndrome. Initial symptoms may be disorientation, weakness, ataxia or difficulty walking, tinnitus, or blurred vision.

Hope that gives you more to go off.

 

[3dee]

Epidural = "eye-pidural" = eye-shaped.

so whats the difference between that picture and this Subdural hematoma (also eye shaped)

What exactly are suture lines vs dural attachment?

 

[AndyRSC]

That's an epidural, 3dee. They won't try to trick you on the exam. If you have an image to go by instead of a patient presentation, it'll be something like this:

 

[loveoforganic]

I thought the suture lines were the point of dural attachment. In epidural hematomas, the blood fills up within one "balloon" of dura (the balloon is formed by where the dura attaches to the cranium). This is the reason you get the sharp lens-shape to epidural hematomas - the dura is free to move in the middle away from the sutures, but locked tightly to the skull at the sutures. I guess you could theoretically rip through the point of dural attachment, but I would assume that the attachments would either have to have a preexisting weakness or there would need to be significant hypertension