Which intracranial bleed is classically associated with a skull fracture and presents as a lens-shaped hematoma on imaging?

• A. Subdural hematoma
• B. Epidural hematoma
• C. Brain herniation
• D. Concussion

Answer: (B)

The key idea is how the bleed sits and how it shows up on imaging. An epidural hematoma occurs when an arterial vessel, usually the middle meningeal artery, is torn by a skull fracture, most often in the temporal region. The bleeding sits between the skull and the dura, producing a lens-shaped (biconvex) collection on CT that is typically confined by the cranial sutures. This arterial source and the association with a skull fracture explain why the pattern is classically lens-shaped and localized.

Clinically, patients may have a brief loss of consciousness, followed by a lucid interval, and then rapid neurologic deterioration as pressure builds. This trajectory is a hallmark that raises suspicion for an epidural bleed in the trauma setting.

In contrast, a subdural hematoma is crescent-shaped and results from tearing of bridging veins, and it can cross sutures, not typically linked to a single skull fracture in the same way. Brain herniation is a dangerous complication, not a bleed type itself, and concussion is a functional injury without a radiographic hematoma. Therefore, the described imaging and fracture association point most directly to an epidural hematoma.