Epidural hematoma with complete third nerve paralysis in an awake patient

A young adolescent with a large epidural hematoma presented with a complete paralysis of the ipsilateral oculomotor nerve. Prior to evacuation of the clot, the patient was awake and alert, without radiological evidence of skull fracture. Atypical features of pediatric extradural hematoma are reviewed to aid in the recognition of the clinically complex and varied aspects of the treatable disease.