Which of the following is a common intracranial injury seen in moderate-to-severe TBI?

• A. Subarachnoid hemorrhage
• B. Cerebellar atrophy
• C. Epidural hematoma
• D. Intracerebral arachnoid cyst

Answer: (C)

In moderate-to-severe TBI, a common acute intracranial injury is an epidural hematoma, which results from tearing of a branch of the middle meningeal artery often due to a skull fracture, especially of the temporal bone. This bleed sits between the skull and the dura and tends to form a lens-shaped (biconvex) collection that can expand rapidly. Because it’s arterial, blood accumulates quickly, raising intracranial pressure and risking brain herniation if not treated promptly. Clinically, you may see a brief loss of consciousness, a period of seeming recover, and then sudden neurological decline as the hematoma enlarges. The key point is the rapid progression and the need for urgent neurosurgical evacuation to relieve pressure.

Subarachnoid hemorrhage can occur with head trauma too, but it is not the focal, mass-forming lesion that characterizes an epidural hematoma. Cerebellar atrophy is a chronic, degenerative change rather than an acute injury pattern seen in the setting of traumatic brain injury. An intracerebral arachnoid cyst is a congenital lesion and not a typical acute traumatic finding.