A 14-year-old boy is brought to the emergency room following a skateboarding accident in which he hit his head against a concrete wall. He was initially unconscious but then "came to". However, in the emergency room, he is comatose, and skull radiograph reveals a linear fracture of the temporal-parietal region on the left. The best explanation for these findings is:
A Acute subdural hematoma
B Epidural hematoma
C Ruptured berry aneurysm
D Cerebral edema with uncal herniation
E Contusion of frontal lobes
(B) CORRECT. The 'lucid' interval is classic for an epidural hematoma from a tear of the middle meningeal artery. The hematoma accumulates rapidly, because the bleeding is arterial.
M.D., PGY-3 Internal Medicine