A patient loses consciousness after head injury; most likely diagnosis is?

A patient loses consciousness after head injury; most likely diagnosis is?

• A. Epidural hematoma
• B. Subarachnoid hemorrhage
• C. Ischemic stroke
• D. Concussion

Answer: (A)

Loss of consciousness right after head injury most strongly indicates an expanding intracranial bleed from an epidural hematoma. This typically results from rupture of the middle meningeal artery, often with a temporal bone fracture. The arterial bleed can grow rapidly, increasing intracranial pressure and producing a quick neurological decline after an initial injury period. The classic pattern is a brief loss of consciousness at the moment of injury, a lucid interval, then deterioration, though the interval may not always be evident. On imaging, an epidural hematoma appears as a biconvex (lens-shaped) collection that usually does not cross sutures and can cause a dangerous mass effect with brain herniation if not treated promptly, making it a neurosurgical emergency. Subarachnoid hemorrhage from trauma presents differently, with a sudden severe headache and meningismus rather than a focal mass effect; ischemic stroke is unlikely to present immediately after head trauma, and concussion, while possible, typically involves transient symptoms without a rapidly enlarging hematoma.

Loss of consciousness right after head injury most strongly indicates an expanding intracranial bleed from an epidural hematoma. This typically results from rupture of the middle meningeal artery, often with a temporal bone fracture. The arterial bleed can grow rapidly, increasing intracranial pressure and producing a quick neurological decline after an initial injury period. The classic pattern is a brief loss of consciousness at the moment of injury, a lucid interval, then deterioration, though the interval may not always be evident. On imaging, an epidural hematoma appears as a biconvex (lens-shaped) collection that usually does not cross sutures and can cause a dangerous mass effect with brain herniation if not treated promptly, making it a neurosurgical emergency. Subarachnoid hemorrhage from trauma presents differently, with a sudden severe headache and meningismus rather than a focal mass effect; ischemic stroke is unlikely to present immediately after head trauma, and concussion, while possible, typically involves transient symptoms without a rapidly enlarging hematoma.