Talk:Epidural hematoma/GA1

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Reviewer: Tom (LT) (talk · contribs) 03:55, 7 August 2019 (UTC)Reply

I will take this review. I've reviewed 60+ other articles, including relating to medicine and anatomy, and will review this article against the 6 good article criteria. I'll read over this article and have a think, then start the review in 2-3 days. --Tom (LT) (talk) 03:55, 7 August 2019 (UTC)Reply

• Steve Mulch Civic (Pro) just checking you're active? --Tom (LT) (talk) 00:07, 11 August 2019 (UTC)Reply

Yes - ❄️Steve ^talk? 18:35, 12 August 2019 (UTC)Reply

• Overall a very well written and easy to understand article. Some comments are below.
• I think overall the article may benefit from a distinction between small and venous haematomas, and large arterials ones, as that distinction might help distinguish and organise text relating to symptoms, treatment and prognosis.

Sources

• Entering the review, I am concerned by the selection and age of some the sources, most of which are between 10 - 20 years old and some of which I would not consider "high quality" medical sources. In particular:
  • StatsPearls (also, this is cited twice)
  • "Pathology of Brain Damage After Head Injury" and "Centre-coup..." from 2000 and 2001 respectively
  • "McCaffrey P. 2001. "The Neuroscience on the Web Series: CMSD 336 Neuropathologies of Language and Cognition." is not going to be a reliable source on epidural haematomas. Whilst it may comment on epidural haematomas, based o the title it is likely mentioning them as a sidenote to the main topic area.
• EMedicine articles "head trauma", "subdural haematoma", and "epidural haematoma" are all from 2004, 2006, 2006.
• There's no page number for this source " Graham DI and Gennareli TA. Chapter 5, "Pathology of Brain Damage After Head Injury" Cooper P and Golfinos G. 2000. Head Injury, 4th Ed. Morgan Hill, New York. "
• I am interested that the source on "subdural haematomas" is used to cite the fact "If not treated promptly, epidural hematomas can cause tonsillar herniation, resulting in respiratory arrest. The trigeminal nerve (CN V) may be involved late in the process as the pons is compressed, but this is not an important presentation, because the person may already be dead by the time it occurs"

Needs citations

• "The eye will be positioned down and out due to unopposed innervation of the fourth and sixth cranial nerves. ". Also I think you mean 'action' here, not innervation.
• "In the case of epidural hematoma in the posterior cranial fossa, tonsillar herniation causes Cushing's triad: hypertension, bradycardia, and irregular breathing. "
• "The prognosis is better if there was a lucid interval than if the person was comatose from the time of injury. Arterial epidural hematomas usually progress rapidly. However, venous epidural hematomas, caused by a dural sinus tear, are slower. "

Needs verification

• On closer reading of the text there are a number of instances of prose that I will need to go off and verify using additional sources, as they do not match my understanding of this subject
• "CT scans reveal subdural or epidural hematomas in 20% of unconscious people" - I find this very hard to believe. There are so many reasons for loss of consciousness, and this surely varies greatly by country and region. I think this should be reworded.
• Treatment section - "It is extremely rare to not require surgery". I'm not so sure about 'extremely'. This is why I worry about this source. The purpose of statpearls is surely to distil key factoids in an easy to remember manner for students, rather than accurately reflect the current state of evidence based medicine?
• Treatment section - "In contrast to most forms of traumatic brain injury, people with epidural hematoma and a Glasgow Coma Score of 15 (the highest score, indicating the best prognosis) usually have a good outcome if they receive surgery quickly". I am doubtful but will check this. This seems to imply that people who have less symptoms do better (which makes sense), but that this is completely the opposite to other forms of traumatic brain injury (whaaaaattt?)
• "The condition is more common in teenagers and young adults than in older people, because the dura mater sticks more to the skull as a person ages, reducing the probability of a hematoma forming" Another statspearls statement. Are you sure that the condition isn't more common because these age groups do more at risk, physical, traumatic etc. activities and also probably more likely to be hit in the temporal region?
• You state "If not treated promptly, epidural hematomas can cause tonsillar herniation, resulting in respiratory arrest" but then "In the case of epidural hematoma in the posterior cranial fossa, tonsillar herniation causes". This seems to imply tonsillar herniation has different symptoms depending on the cause.

Other comments

• "As blood accumulates, it starts to compress intracranial structures, which may impinge on the third cranial nerve,[6] causing a fixed and dilated pupil on the side of the injury.[6]" Yes this may be true but I think organising the paragraph in order of what symptoms are more likely is likely to be more helpful
• "and vision loss, also on the opposite side, due to compression of the posterior cerebral artery" - I think you mean "loss of the visual field on the side opposite to the lesion" to more clearly indicate that the opposing eye doens't completely have visual loss (which many readers may think)
• "A venous hematoma may be acute (occurring within a day of the injury and appearing as a swirling mass of blood without a clot), subacute (occurring in 2–4 days and appearing solid), or chronic (occurring in 7–20 days and appearing mixed or lucent)" - "appearing as..." should mention on what. Visual appearance? Radiological?
• Diagnosis
  • "Differential diagnoses include a transient ischemic attack, intracranial mass, or brain abscess." Based on the dsecription provided and number of symptoms, I suggest add "stroke or transient ischaemic attack" to your list of differentials. The definition of a TIA is that symptoms have resolved.
• Treatment
  • "Without surgery, death usually follows, due to enlargement of the hematoma, causing a brain herniation" (treatment section). You mention this fact, and link brain herniation, several times. I suggest trim this from some sections and wikilink only the first instance.
  • "prolonged trephination (drilling a hole into the skull) may be performed in the emergency department" - why is it "prolonged"?

Prose

• Signs and symptoms - remove "CN V" from "The trigeminal nerve (CN V) " - the fact that the trigeminal nerve is considered in standard anatomy to be the fifth pair of cranial nerves is immaterial and tangential to this article.  Done
• Prognosis - "About 2% of head injuries and 15 percent " suggest stick with "%" or "percent" but not both.  Done

Images

• I also particularly appreciate how the images are well captioned and easy to understand in general.
• "The interior of the skull has sharp ridges by which a moving brain can be injured." - do you mean many sharp ridges which can tear an artery? This caption reads a little odd to me.
• "Non-contrast CT scan of a traumatic acute hematoma in the left fronto-temporal area." in fact shows one on the RIGHT
• "The grey area in the top left is organizing hematoma, causing midline shift and compression of the ventricle". Suggest link ventricles
• Images are all relevant and there are no issues when viewed on commons. I've also added captions to them all on commons.

Copyvio

I used Earwig's copyvio checker. Single instance of direct copyvio identified:

• "In adults, up to 75% of EDHs occur in the temporal region. However, in children, they occur with similar frequency in the temporal, occipital, frontal, and posterior fossa regions." - from StatsPearls

Happy to discuss the above. Looking forward to your responses. I don't see anything that should stop this article becoming a GA, but rather some areas that may need to be addressed during the course of this review. I am yet to verify citations, check images, and check for plagiarism. Cheers --Tom (LT) (talk) 00:57, 11 August 2019 (UTC)Reply

Update:   failed

I have a number of concerns with this article as documented above. It is not ready to be a GA and there has been minimal response from the nominator after about a month. After these concerns are addressed I encourage renomination. Good luck next time! --Tom (LT) (talk) 07:20, 3 September 2019 (UTC)Reply