542:
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385:, is relatively weak and prone to injury. Only 20 to 30% of epidural hematomas occur outside the region of the temporal bone. The brain may be injured by prominences on the inside of the skull as it scrapes past them. Epidural hematoma is usually found on the same side of the brain which was impacted by the blow, but on very rare occasions it can be due to a
625:
About 2 percent of head injuries and 15 percent of fatal head injuries involve an epidural hematoma. The condition is more common in teenagers and young adults than in older people, because the dura mater sticks more to the skull as a person ages, reducing the probability of a hematoma forming. Males
616:
Outcomes are worse if there is more than 50 mL of blood in the hematoma before surgery. Age, pupil abnormalities, and
Glasgow Coma Scale score on arrival to the emergency department also influence the prognosis. In contrast to most forms of traumatic brain injury, people with epidural hematoma and a
514:
Epidural hematomas may occur in combination with subdural hematomas, or either may occur alone. CT scans reveal subdural or epidural hematomas in 20% of unconscious people. In the hallmark of epidural hematoma, people may regain consciousness and appear completely normal during what is called a
432:
and can progress more slowly. A venous hematoma may be acute (occurring within a day of the injury and appearing as a swirling mass of blood without a clot), subacute (occurring in 2–4 days and appearing solid), or chronic (occurring in 7–20 days and appearing mixed or lucent).
283:
immediately following the injury, with a delay before symptoms become evident. Because of this initial period of lucidity, it has been called "Talk and Die" syndrome. As blood accumulates, it starts to compress intracranial structures, which may impinge on the
374:, although spontaneous hemorrhages have been known to occur. Epidural hematomas occur in about 10% of traumatic brain injuries, mostly due to car accidents, assaults, or falls. They are often caused by acceleration-deceleration trauma and transverse forces.
525:
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The prognosis is better if there was a lucid interval than if the person was comatose from the time of injury. Arterial epidural hematomas usually progress rapidly. However, venous epidural hematomas, caused by a dural sinus tear, are slower.
1171:
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1288:
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Epidural hemorrhage (epidural hematoma, extradural hemorrhage, or hematoma) Bleeding outside the outermost layer of the dural mater, which is thus stripped away from the inner table of the skull or spinal
603:
above 8, and no visible neurological symptoms, then it may be possible to treat it conservatively. A CT scan should be performed, and watchful waiting should be done, as the hematoma may suddenly expand.
541:
1281:
1059:
Smith SW, Clark M, Nelson J, Heegaard W, Lufkin KC, Ruiz E (2010). "Emergency department skull trephination for epidural hematoma in patients who are awake but deteriorate rapidly".
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519:, only to descend suddenly and rapidly into unconsciousness later. This lucid interval, which depends on the extent of the injury, is a key to diagnosing an epidural hematoma.
1597:
396:, causing contraction and exfoliation of the dura mater and exfoliate from the skull, in turn causing exudation of blood from the venous sinuses. The hematoma can be seen on
1686:
460:, causing the brain to shift, lose blood supply, be crushed against the skull, or herniate. Larger hematomas cause more damage. Epidural bleeds can quickly compress the
933:
Graham DI and
Gennareli TA. Chapter 5, "Pathology of Brain Damage After Head Injury" Cooper P and Golfinos G. 2000. Head Injury, 4th Ed. Morgan Hill, New York.
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338:
is compressed, but this is not an important presentation, because the person may already be dead by the time it occurs. In the case of epidural hematoma in the
596:
Medications may be given after surgery. They may include antiseizure medications and hyperosmotic agents to reduce brain swelling and intracranial pressure.
507:, where the dura mater is tightly attached to the skull. Thus, they expand inward toward the brain rather than along the inside of the skull, as occurs in
448:
regions. Epidural bleeds from arteries can grow until they reach their peak size 6–8 hours post-injury, spilling 25–75 cubic centimeters of blood into the
573:. Delayed surgery can result in permanent brain damage or death. Without surgery, death usually follows, due to enlargement of the hematoma, causing a
944:
51:
with overlying skull fracture. Note the biconvex shaped collection of blood. There is also bruising with bleeding on the opposite side of the brain.
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It is extremely rare to not require surgery. If the volume of the epidural hematoma is less than 30 mL, the clot diameter less than 15 mm, a
1124:
1679:
1631:
593:(drilling a hole into the skull) may be performed in the emergency department. Large hematomas and blood clots may require an open craniotomy.
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899:
1938:
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Glasgow Coma Score of 15 (the highest score, indicating the best prognosis) usually have a good outcome if they receive surgery quickly.
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Kawasumi, Y.; Usui, A.; Hosokai, Y.; Sato, M.; Funayama, M. (2013). "Heat haematoma: Post-mortem computed tomography findings".
1885:
1729:
1567:
581:, the blood almost always must be removed surgically to reduce the pressure on the brain. The hematoma is evacuated through a
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and should be used if there is a high suspicion of epidural hematoma and a negative CT scan. Differential diagnoses include a
202:
following a head injury, a brief regaining of consciousness, and then loss of consciousness again. Other symptoms may include
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In adults, the temporal region accounts for 75% of cases. In children, however, they occur with similar frequency in the
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Nontraumatic epidural hematoma in a young woman. The grey area in the top right is organizing hematoma, causing
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on the side of the injury. The eye will be positioned down and out due to unopposed innervation of the
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Epidural hematomas usually appear convex in shape because their expansion stops at the skull's
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Epidural hematoma commonly results from a blow to the side (temporal bone) of the head. The
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897:"The Neuroscience on the Web Series: CMSD 336 Neuropathologies of Language and Cognition."
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Non-contrast CT scan of a traumatic acute hematoma in the right fronto-temporal area.
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271:. Typically it occurs in young adults. Males are more often affected than females.
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The interior of the skull has sharp ridges by which a moving brain can be injured.
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Extradural hematoma, epidural hemorrhage, epidural haematoma, epidural bleeding
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311:; and vision loss, also on the opposite side, due to compression of the
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452:. As the hematoma expands, it strips the dura from the inside of the
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191:. When this condition occurs in the spinal canal, it is known as a
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California State
University, Chico. Retrieved on February 6, 2007.
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are high-pressure flow. In 10% of cases, however, it comes from
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A "heat hematoma" is an epidural hematoma caused by severe
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The most common cause of intracranial epidural hematoma is
829:
at
Medscape. Author: Daniel D Price. Updated: Nov 3, 2010
248:
Treatment is generally by urgent surgery in the form of a
703:
408:, because of heat-induced coagulation of the hematoma.
322:
If not treated promptly, epidural hematomas can cause
1098:"Epidural hematoma: MedlinePlus Medical Encyclopedia"
1134:
1130:
Epidural hematoma | Radiology Case | Radiopaedia.org
841:"Probing Question: What is 'Talk and Die' Syndrome?"
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2014:
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Spinal cord injury without radiographic abnormality
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978:
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706:. Lippincott Williams & Wilkins. p. 1256.
158:
123:
110:
92:
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55:
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24:
945:"Contre-coup extradural haematoma: A short report"
673:Ferri's Clinical Advisor 2017 E-Book: 5 Books in 1
16:Build-up of blood between the dura mater and skull
456:, causing an intense headache. It also increases
279:Many people with epidural hematomas experience a
256:, or (in the case of a spinal epidural hematoma)
267:The condition occurs in one to four percent of
1680:
1426:
1282:
1029:Emedicine.com. Retrieved on February 6, 2007.
924:Emedicine.com. Retrieved on February 6, 2007.
867:Emedicine.com. Retrieved on February 6, 2007.
424:, hence epidural bleeding is often rapid as
229:. Occasionally it can occur as a result of a
8:
883:, March 2005, Retrieved on February 6, 2007.
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879:University of Vermont College of Medicine.
334:may be involved late in the process as the
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511:. Most people also have a skull fracture.
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676:. Elsevier Health Sciences. p. 441.
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472:, and abnormal pupil responses to light.
799:. Oxford University Press. p. 335.
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315:. In rare cases, small hematomas may be
827:Epidural Hematoma in Emergency Medicine
754:Khairat, Ali; Waseem, Muhammad (2018),
635:
559:A diagram showing an epidural hematoma.
521:
185:tough outer membrane covering the brain
1297:Nonmusculoskeletal injuries of head (
1092:
1090:
7:
1939:Partial anterior circulation infarct
881:"Neuropathology: Trauma to the CNS."
875:
873:
208:inability to move parts of the body
1934:Total anterior circulation infarct
1735:Posterior cerebral artery syndrome
14:
1725:Anterior cerebral artery syndrome
535:and compression of the ventricle.
2108:Cerebral venous sinus thrombosis
1533:Chronic traumatic encephalopathy
1049:. Retrieved on February 6, 2007.
793:Pryse-Phillips, William (2009).
626:are affected more than females.
552:
540:
524:
1886:Anterior spinal artery syndrome
1730:Middle cerebral artery syndrome
1568:Anterior spinal artery syndrome
796:Companion to Clinical Neurology
221:that results in a break of the
47:Epidural hematoma as seen on a
1073:10.1016/j.jemermed.2009.04.062
839:Penn State University (2009).
342:, tonsillar herniation causes
303:Other symptoms include severe
288:, causing a fixed and dilated
237:. Diagnosis is typically by a
206:, confusion, vomiting, and an
1:
1891:Vertebrobasilar insufficiency
1040:"Tutorial: CT in Head Trauma"
943:Mishra A, Mohanty S (2001).
210:. Complications may include
1471:Intraventricular hemorrhage
1466:Intraparenchymal hemorrhage
1025:Singh J and Stock A. 2006.
381:region, which overlies the
354:, and irregular breathing.
2150:
1860:Cerebellar stroke syndrome
1793:Lateral medullary syndrome
997:10.1016/j.crad.2012.10.019
700:Pooler, Charlotte (2009).
480:Diagnosis is typically by
2085:Charcot–Bouchard aneurysm
1929:Transient ischemic attack
1896:Subclavian steal syndrome
1788:Medial medullary syndrome
1778:Brainstem stroke syndrome
1644:Injury of accessory nerve
1125:MedPix: Epidural hematoma
1045:November 6, 2005, at the
762:, StatPearls Publishing,
577:. As with other types of
494:transient ischemic attack
420:causes bleeding from the
313:posterior cerebral artery
235:blood vessel malformation
142:transient ischemic attack
105:blood vessel malformation
46:
37:
2129:Cerebrovascular diseases
1967:Transient global amnesia
1814:Lateral pontine syndrome
1750:Dejerine–Roussy syndrome
1696:Cerebrovascular diseases
1518:Post-concussion syndrome
496:, intracranial mass, or
309:crossed pyramid pathways
193:spinal epidural hematoma
2058:Intracranial hemorrhage
1876:Carotid artery stenosis
1805:Medial pontine syndrome
1627:Peripheral nerve injury
1593:Posterior cord syndrome
1550:Penetrating head injury
1491:Subarachnoid hemorrhage
1458:Intracranial hemorrhage
1400:Penetrating head injury
670:Ferri, Fred F. (2016).
569:Epidural hematoma is a
422:middle meningeal artery
383:middle meningeal artery
340:posterior cranial fossa
227:middle meningeal artery
217:The cause is typically
134:subarachnoid hemorrhage
1649:Brachial plexus injury
1639:Wallerian degeneration
1573:Brown-SĂ©quard syndrome
1523:Second-impact syndrome
1450:Traumatic brain injury
579:intracranial hematomas
367:
225:and bleeding from the
138:traumatic brain injury
125:Differential diagnosis
2080:Intracranial aneurysm
1869:Extracranial arteries
1583:Central cord syndrome
1578:Cauda equina syndrome
1540:Diffuse axonal injury
458:intracranial pressure
365:
200:loss of consciousness
187:(dura mater) and the
77:Headache, confusion,
2016:Cerebral/Intra-axial
1962:Binswanger's disease
1528:Dementia pugilistica
865:"Subdural Hematoma."
488:. MRIs have greater
400:as brick red, or as
324:tonsillar herniation
298:sixth cranial nerves
262:spinal decompression
149:intracranial abscess
2103:Cerebral vasculitis
1981:Haemorrhagic stroke
1919:Cerebral infarction
1545:Abusive head trauma
1508:Cerebral laceration
895:McCaffrey P. 2001.
756:"Epidural Hematoma"
286:third cranial nerve
183:occurs between the
2042:Duret haemorrhages
1560:Spinal cord injury
1503:Cerebral contusion
1380:Perforated eardrum
1213:External resources
985:Clinical Radiology
920:Shepherd S. 2004.
902:2007-04-06 at the
601:Glasgow Coma Score
571:surgical emergency
509:subdural hematomas
470:abnormal posturing
450:intracranial space
368:
328:respiratory arrest
275:Signs and symptoms
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1975:
1974:
1840:Claude's syndrome
1835:Benedikt syndrome
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1654:Traumatic neuroma
1614:Peripheral nerves
1486:Epidural hematoma
1481:Subdural hematoma
1408:
1407:
1388:
1387:
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1255:Epidural hematoma
863:Wagner AL. 2006.
416:The break of the
387:contrecoup injury
231:bleeding disorder
177:Epidural hematoma
174:
173:
130:Subdural hematoma
112:Diagnostic method
101:bleeding disorder
25:Epidural hematoma
19:Medical condition
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2024:Intraventricular
1986:
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1755:Watershed stroke
1745:Moyamoya disease
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1708:Ischaemic stroke
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1027:"Head Trauma."
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991:(2): e95–e97.
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922:"Head Trauma."
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622:
619:
609:
606:
566:
563:
562:
561:
558:
551:
549:
546:
539:
537:
530:
523:
517:lucid interval
477:
474:
413:
410:
359:
356:
276:
273:
172:
171:
160:
156:
155:
127:
121:
120:
114:
108:
107:
94:
90:
89:
86:
82:
81:
75:
69:
68:
59:
53:
52:
44:
43:
35:
34:
31:
27:
26:
18:
15:
13:
10:
9:
6:
4:
3:
2:
2146:
2135:
2132:
2130:
2127:
2126:
2124:
2109:
2106:
2104:
2101:
2100:
2098:
2094:
2086:
2083:
2082:
2081:
2078:
2077:
2075:
2073:
2069:
2059:
2056:
2055:
2053:
2049:
2043:
2040:
2039:
2037:
2035:
2031:
2025:
2022:
2021:
2019:
2017:
2013:
2007:
2004:
2002:
1999:
1997:
1994:
1993:
1991:
1987:
1984:
1982:
1978:
1968:
1965:
1963:
1960:
1958:
1955:
1954:
1952:
1948:
1940:
1937:
1935:
1932:
1930:
1927:
1926:
1925:
1922:
1920:
1917:
1915:
1912:
1911:
1909:
1905:
1897:
1894:
1893:
1892:
1889:
1887:
1884:
1882:
1879:
1877:
1874:
1873:
1871:
1867:
1861:
1858:
1857:
1855:
1853:
1849:
1841:
1838:
1836:
1833:
1831:
1828:
1827:
1826:
1823:
1819:
1815:
1812:
1810:
1806:
1803:
1802:
1801:
1798:
1794:
1791:
1789:
1786:
1785:
1784:
1781:
1779:
1776:
1775:
1773:
1771:
1767:
1761:
1758:
1756:
1753:
1751:
1748:
1746:
1743:
1741:
1738:
1736:
1733:
1731:
1728:
1726:
1723:
1722:
1720:
1718:
1714:
1711:
1709:
1705:
1701:
1697:
1690:
1685:
1683:
1678:
1676:
1671:
1670:
1667:
1655:
1652:
1650:
1647:
1645:
1642:
1640:
1637:
1633:
1630:
1628:
1625:
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1620:
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1611:
1604:
1601:
1599:
1596:
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1584:
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1579:
1576:
1574:
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1569:
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1557:
1551:
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1534:
1531:
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1526:
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1521:
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1515:
1514:
1511:
1509:
1506:
1504:
1501:
1499:
1496:
1492:
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1487:
1484:
1482:
1479:
1478:
1476:
1472:
1469:
1467:
1464:
1463:
1461:
1459:
1456:
1455:
1453:
1451:
1447:
1443:
1436:
1431:
1429:
1424:
1422:
1417:
1416:
1413:
1401:
1398:
1397:
1395:
1391:
1381:
1378:
1377:
1375:
1373:
1371:
1366:
1360:
1357:
1355:
1352:
1350:
1347:
1346:
1344:
1342:
1340:
1335:
1332:
1330:
1329:facial trauma
1326:Extracranial/
1324:
1318:
1317:
1312:
1311:
1309:
1305:
1300:
1292:
1287:
1285:
1280:
1278:
1273:
1272:
1269:
1256:
1252:
1251:
1247:
1245:
1242:
1239:
1235:
1234:
1230:
1228:
1224:
1223:
1219:
1218:
1215:
1211:
1204:
1200:
1199:
1195:
1193:
1189:
1188:
1184:
1182:
1178:
1177:
1173:
1169:
1167:
1163:
1159:
1158:
1154:
1150:
1149:
1146:
1141:
1137:
1131:
1128:
1126:
1123:
1122:
1118:
1103:
1099:
1093:
1091:
1087:
1082:
1078:
1074:
1070:
1067:(3): 377–83.
1066:
1062:
1055:
1052:
1048:
1044:
1041:
1035:
1032:
1028:
1022:
1019:
1014:
1010:
1006:
1002:
998:
994:
990:
986:
979:
977:
973:
962:
958:
954:
950:
946:
939:
936:
930:
927:
923:
917:
915:
913:
909:
905:
901:
898:
892:
890:
886:
882:
876:
874:
870:
866:
860:
857:
846:
842:
835:
832:
828:
823:
821:
817:
813:
808:
806:9780199710041
802:
798:
797:
789:
787:
785:
783:
779:
769:
765:
761:
757:
750:
748:
746:
744:
742:
740:
738:
736:
734:
732:
730:
728:
726:
724:
720:
715:
713:9781605477817
709:
705:
704:
696:
694:
690:
685:
683:9780323448383
679:
675:
674:
666:
664:
662:
660:
658:
656:
654:
652:
650:
648:
646:
644:
642:
640:
636:
629:
627:
620:
618:
614:
607:
605:
602:
597:
594:
592:
588:
584:
580:
576:
572:
564:
555:
550:
543:
538:
534:
533:midline shift
527:
522:
520:
518:
512:
510:
506:
501:
499:
498:brain abscess
495:
491:
487:
483:
475:
473:
471:
467:
463:
459:
455:
451:
447:
443:
439:
434:
431:
427:
423:
419:
418:temporal bone
411:
409:
407:
403:
399:
395:
390:
388:
384:
380:
375:
373:
364:
357:
355:
353:
349:
345:
341:
337:
333:
329:
325:
320:
318:
314:
310:
306:
301:
299:
295:
291:
287:
282:
274:
272:
270:
269:head injuries
265:
263:
259:
255:
251:
246:
244:
240:
236:
232:
228:
224:
223:temporal bone
220:
215:
213:
209:
205:
201:
198:There may be
196:
194:
190:
186:
182:
178:
169:
165:
161:
157:
154:
150:
146:
143:
139:
135:
131:
128:
126:
122:
118:
115:
113:
109:
106:
102:
98:
95:
91:
87:
83:
80:
76:
74:
70:
67:
63:
60:
58:
54:
50:
45:
41:
36:
32:
28:
23:
2006:Subarachnoid
1995:
1622:Nerve injury
1485:
1477:Extra-axial
1462:Intra-axial
1368:
1337:
1313:
1307:Intracranial
1248:
1231:
1220:
1196:
1185:
1170:
1151:
1105:. Retrieved
1101:
1064:
1060:
1054:
1034:
1021:
988:
984:
964:. Retrieved
955:(94): 94–5.
952:
948:
938:
929:
859:
848:. Retrieved
844:
834:
810:
795:
771:, retrieved
759:
702:
672:
624:
621:Epidemiology
615:
611:
598:
595:
591:trephination
568:
513:
502:
479:
435:
415:
394:thermal burn
391:
376:
369:
348:hypertension
321:
317:asymptomatic
302:
281:lucid period
278:
266:
247:
216:
197:
176:
175:
62:Neurosurgery
2134:Neurotrauma
1989:Extra-axial
1881:precerebral
1603:Tetraplegia
1442:Neurotrauma
1393:Either/both
1316:neurotrauma
1299:head injury
1222:MedlinePlus
1061:J Emerg Med
845:www.psu.edu
490:sensitivity
402:radiolucent
372:head injury
352:bradycardia
219:head injury
153:brain tumor
97:Head injury
85:Usual onset
30:Other names
2123:Categories
1852:Cerebellum
1770:Brain stem
1698:including
1588:Paraplegia
1513:Concussion
1354:Eye injury
1301:) and neck
1250:Patient UK
1198:DiseasesDB
1107:2019-02-12
966:2008-01-24
850:2022-03-26
773:2019-02-13
760:StatPearls
630:References
587:craniotomy
464:, causing
258:laminotomy
250:craniotomy
164:craniotomy
2034:Brainstem
1809:Foville's
1349:Black eye
1244:neuro/574
1238:emerg/167
1233:eMedicine
1005:0009-9260
608:Prognosis
583:burr hole
565:Treatment
476:Diagnosis
462:brainstem
438:occipital
254:burr hole
168:burr hole
162:Surgery (
159:Treatment
119:(CT scan)
79:paralysis
66:Neurology
57:Specialty
2072:Aneurysm
2001:Subdural
1996:Epidural
1825:Midbrain
1241:med/2898
1081:19535215
1043:Archived
1013:23219455
961:11303253
900:Archived
768:30085524
426:arteries
305:headache
243:MRI scan
212:seizures
204:headache
181:bleeding
179:is when
73:Symptoms
2051:General
1957:CADASIL
1783:Medulla
1192:D006407
505:sutures
482:CT scan
442:frontal
406:CT scan
398:autopsy
379:pterion
239:CT scan
145:seizure
49:CT scan
1700:stroke
1227:001412
1079:
1011:
1003:
959:
812:canal.
803:
766:
710:
680:
444:, and
358:Causes
330:. The
294:fourth
93:Causes
2096:Other
1950:Other
1717:Brain
1181:432.0
1166:S06.4
1162:I62.1
454:skull
430:veins
290:pupil
260:with
189:skull
88:Rapid
1800:Pons
1314:see
1203:4353
1187:MeSH
1176:9-CM
1077:PMID
1009:PMID
1001:ISSN
957:PMID
801:ISBN
764:PMID
708:ISBN
678:ISBN
336:pons
296:and
1370:ear
1339:eye
1172:ICD
1153:ICD
1069:doi
993:doi
585:or
486:MRI
484:or
404:on
252:or
241:or
233:or
2125::
1816:/
1807:/
1253::
1236::
1225::
1201::
1190::
1179::
1164:,
1160::
1157:10
1100:.
1089:^
1075:.
1065:39
1063:.
1007:.
999:.
989:68
987:.
975:^
953:49
951:.
947:.
911:^
888:^
872:^
843:.
819:^
809:.
781:^
758:,
722:^
692:^
638:^
500:.
468:,
440:,
389:.
350:,
346::
319:.
300:.
264:.
245:.
214:.
195:.
166:,
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140:,
136:,
132:,
103:,
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64:,
1688:e
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1674:v
1434:e
1427:t
1420:v
1372::
1341::
1290:e
1283:t
1276:v
1174:-
1155:-
1145:D
1110:.
1083:.
1071::
1015:.
995::
969:.
853:.
716:.
686:.
170:)
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