This is a dural artery that is susceptible to injury.
The dural artery is particularly susceptible to injury in cases of temporal bone fracture. This is because the fracture lines cross the dural artery during its course.
Typically the dura is tight to the skull; however, under arterial pressure a hematoma can develop.
Epidural hematoma can lead to transtentorial herniation which can result in compression of Cranial Nerve III. This manifests as a fixed dilated pupil and inability to accommodate the lens.
Slow accumulation of blood can lead to delayed onset of neurological signs. Patients may feel fine initially after injury, and have a "lucid interval" before serious complications.
Epidural hematoma appears lens-shaped on CT versus subdural hematoma, which is crescentic in shape.
The bleed does not cross suture lines due to superior attachment of the dura to the periosteum at the sutures.
Early surgical intervention via craniotomy or burr hole to relieve pressure has been demonstrated to improve mortality.
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