After a motorcycle crash, a patient briefly loses consciousness, wakes up, then becomes unconscious again two hours later. Which intracranial injury should you suspect?

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A lucid interval after head trauma points to an epidural hematoma. This type of bleed usually results from a skull fracture that tears the middle meningeal artery, allowing blood to accumulate between the dura and the skull. The child-like pattern of loss of consciousness at impact, a brief period of wakefulness with clear mental status, and then rapid deterioration as the hematoma expands is classic. The blood forms a lens-shaped (biconvex) collection on imaging and tends to escalate quickly, causing increasing pressure on the brain.

This differs from a subdural hematoma, which comes from torn bridging veins and often presents with a slower, more variable onset and a crescent-shaped bleed that crosses sutures. A concussion involves transient dysfunction without a lasting structural bleed. An intracerebral hemorrhage is bleeding within the brain tissue itself and typically presents with focal neurological deficits and more direct impairment rather than a lucid interval pattern.