Epidural Hematoma is the Type of Bleed Most Commonly Associated with Cranial Fractures
Epidural hematoma (EDH) is the classic intracranial hemorrhage associated with skull fractures, occurring in approximately 80% of cases with parietal, temporal, or temporo-parietal fractures accounting for 63% of all epidural hematomas. 1
Epidemiologic Evidence
- Skull fractures are present in 80% of patients with epidural hematomas, establishing this as the strongest association between cranial fractures and a specific bleed type 1
- The temporal bone region is particularly vulnerable, with temporal and temporo-parietal fractures being the most common locations for EDH development 1
- All patients with skull fractures in one surgical series had fractures present, though the reverse is not always true 2
Critical Clinical Pitfall
Approximately 20% of epidural hematomas occur WITHOUT skull fractures, so the absence of a fracture does not exclude EDH 1. Conversely, when skull fractures are detected on plain radiography but not on initial CT, half of these patients may subsequently develop epidural hematomas 1.
Mechanism and Pathophysiology
- EDH typically results from arterial bleeding (most commonly middle meningeal artery) associated with skull fracture lines crossing vascular grooves 1
- The fracture itself does not determine prognosis; rather, the associated intracranial injury is the critical factor 1
Monitoring Requirements for Fracture-Associated EDH
- Repeat CT scanning is essential in patients with temporal/parietal fractures and initially small epidural hematomas, as delayed expansion can occur 1
- Deterioration has been documented 6-30 hours after initial presentation despite initially normal CT findings 1
- In rare cases, progressive EDH can occur up to 6 days after trauma, particularly in young patients with linear fractures 3
Other Hemorrhage Types with Fractures
While subdural hematoma can also occur with skull fractures (particularly in high-energy trauma and frontal sinus fractures), the association is less specific than with epidural hematoma 4, 5.