Torn meningeal vessels: an evaluation of a clinical spectrum through the use of angiography.

Modern medical knowledge of the clinical and pathological aspects of epidural hematoma dates from the nineteenth century (Jacobson, 17). Reference to head injuries, however, may be found in much earlier medical writings (5). As reports of this entity have accumulated in the literature, an analysis of the cases has led to the formulation and promulgation of rather rigid clinical diagnostic criteria. Today it is generally accepted, however, that the clinical spectrum seen with epidural hematomas is wide. Thus, although classical descriptions of the symptomatology include the “lucid interval,” such a history is obtained less than 50 per cent of the time...and although the classical description includes progression to a fatal outcome within hours, exceptions are fairly common in our experience and in that of others (16, 31, 36). The explanation for this variability is complex. Certain anatomic factors may be responsible in part. One such factor is the strength of attachment of the dura to the skull. The dura ...