Premonitory neurologic signs in a patient with an acute vertex epidural hematoma

A case of an acute vertex epidural hematoma with delayed neurologic deterioration is presented. Prior to the onset of signs of midbrain compression, the patient developed an excrutiating headache, a movement disorder, and upper motor neuron signs. A review of the literature and this case suggest that the presence of a severe, unrelenting headache and upper motor neuron signs in a victim of head trauma may be secondary to compression of the parasagittal brain region by a vertex hematoma.