A patient sustains a temporal bone fracture with rupture of the middle meningeal artery. He is initially lucid but deteriorates rapidly. What is the diagnosis?

Correct answer: A. Epidural (extradural) haematoma

• A. CORRECT. The triad of TEMPORAL BONE FRACTURE, MIDDLE MENINGEAL ARTERY rupture and a LUCID INTERVAL followed by rapid deterioration is the classic description of an EPIDURAL HAEMATOMA. Arterial bleeding strips the dura from the inner table of the skull, producing a biconvex (lens-shaped) collection on CT that does NOT cross suture lines. Deterioration is fast because the bleeding is arterial and under pressure; it is a NEUROSURGICAL EMERGENCY requiring immediate evacuation.
• B. CONCUSSION is a transient functional disturbance with no structural lesion and no expanding mass; it does not cause progressive deterioration.
• C. SUBDURAL HAEMATOMA results from tearing of BRIDGING VEINS, is crescent-shaped, DOES cross suture lines, and is typically slower in onset — especially in the elderly and in alcoholics, where it may present weeks after minor trauma.
• D. SUBARACHNOID HAEMORRHAGE classically follows rupture of a berry aneurysm and presents with a sudden 'worst headache of my life' and meningism, with blood in the basal cisterns — not with a lucid interval after temporal trauma.

Note: Any patient who loses consciousness after facial or head trauma, or who has a lucid interval, needs urgent medical evaluation — this is a genuine emergency the dental team may witness after a fall or assault. Warning signs: worsening headache, repeated vomiting, unequal pupils, and falling GCS.