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Updated: Aug 6, 2026

Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
09:01

Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation

Published on: October 15, 2021

Challenges in characterization of intracranial epidural hematoma

Iman Feiz-Erfan1, Christopher M Knapp2, Poya Hedayati3

  • 1Division of Neurosurgery, Valleywise Health Medical Center, Phoenix, AZ, United States; Creighton University, School of Medicine, Phoenix, AZ, United States; University of Arizona, College of Medicine, Phoenix, AZ, United States.

Clinical Neurology and Neurosurgery
|July 16, 2026
PubMed

Insights

Radiologists often mischaracterize epidural hematomas (EDH), especially thinner or unusually shaped ones, labeling them as subdural hematomas (SDH). This diagnostic challenge may delay crucial neurosurgical consultations for traumatic brain injuries.

Area of Science:

  • Neurosurgery
  • Radiology
  • Traumatic Brain Injury

Background:

  • Current brain injury guidelines (BIG) classify intracranial hematomas (ICH), with epidural hematomas (EDH) requiring further neurosurgical attention.
  • Differentiating EDH from other ICH, particularly subdural hematomas (SDH), presents a diagnostic challenge not systematically assessed in recent times.

Purpose of the Study:

  • To assess the accuracy of radiographic characterization of acute, traumatic cranial EDH.
  • To identify factors influencing mischaracterization of EDH in radiology reports.

Main Methods:

  • Retrospective review of imaging for surgically proven acute, traumatic cranial EDH (2007-2023).
  • Analysis of radiology reports for EDH characterization.
  • Correlation of radiographic features and radiologist subspecialty with report accuracy.

Main Results:

  • Of 117 EDH in 112 patients, 41.5% were insufficiently characterized in radiology reports, often mislabeled as SDH or extra-axial hematoma.
  • Mischaracterization rates were higher for EDH with non-classic shapes (70.1%), crossing suture lines (54%), or thickness ≤7 mm (67.16%).
  • General radiologists had higher mischaracterization rates (50.9%) compared to neuroradiologists (28%).

Conclusions:

  • A significant rate of insufficient characterization of EDH occurs in radiographic diagnoses.
  • Mischaracterization is elevated for non-classic or thinner EDH, potentially leading to omitted neurosurgical consultations.
  • Considering the site of impact during radiographic interpretation may improve EDH characterization.
Abstract

Keywords:
Epidural hemorrhageExtradural hematomaHead injuryMisreadRadiographic error

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