## Investigation of Choice for Acute Epidural Hematoma **Key Point:** Non-contrast CT (NCCT) head is the gold standard for acute epidural hematoma due to its speed, sensitivity, and ability to detect blood and assess mass effect. ### Why NCCT is Preferred 1. **Speed** — Acquired in seconds; critical in acute trauma with potential herniation risk 2. **Sensitivity** — Acute blood appears hyperdense (white) on NCCT, easily distinguishable from brain parenchyma 3. **Availability** — Present in all emergency departments; no contraindications 4. **Mass effect assessment** — Shows midline shift, compression of ventricles, and herniation signs ### Classic CT Findings in Epidural Hematoma | Feature | Description | |---------|-------------| | **Shape** | Lens-shaped (biconvex) | | **Location** | Between skull and dura | | **Density** | Hyperdense in acute phase | | **Boundaries** | Does NOT cross suture lines | | **Associated injury** | Often with skull fracture | **Clinical Pearl:** The lens-shaped appearance is pathognomonic because the dura is adherent to the skull at suture lines, preventing blood from crossing them — unlike subdural hematoma, which is crescent-shaped and crosses sutures. **High-Yield:** In acute epidural hematoma with signs of herniation (blown pupil, posturing), do NOT wait for imaging — proceed directly to neurosurgery for burr holes or craniotomy. 
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