Which head injury involves bleeding beneath the skull above the dura mater and is typically arterial in origin?

• A. Subdural hematoma
• B. Epidural hematoma
• C. Subarachnoid hemorrhage
• D. Intracerebral hemorrhage

Answer: (B)

The key idea is the location and origin of the bleeding. An epidural hematoma is blood that collects between the skull and the dura mater. It’s classically caused by tearing of the middle meningeal artery, which is an arterial source, so the bleed tends to accumulate quickly and worsen rapidly after the injury. A hallmark is a period of being briefly unconscious at the time of injury, then a lucid interval before rapid deterioration as pressure builds.

In contrast, a subdural hematoma occurs beneath the dura, between dura and arachnoid, and is usually venous in origin from bridging veins, so it often accumulates more slowly and can present days or weeks after the injury. A subarachnoid hemorrhage involves bleeding into the space around the brain itself (subarachnoid space) and is commonly due to aneurysm rupture or trauma, presenting with a sudden, severe headache and meningismus. An intracerebral hemorrhage is bleeding within the brain tissue, caused by vessel rupture inside the brain, leading to focal neurological deficits.

So the scenario described—bleeding beneath the skull above the dura mater and typically arterial in origin—fits an epidural hematoma.