A 16-year-old male fell while skateboarding and lost consciousness for an unknown period of time, with concern for subsequent tonic seizure. He was taken to the nearest emergency room. Initial GCS was 14/15.

Head CT showed right squamous temporal bone fracture with epidural hematoma and midline shift ( Fig. 66.1 ). He was taken immediately to the operating room for decompression, as his mental status deteriorated overnight.

Epidural hematoma. Head CT, (A) axial soft tissue window shows lenticular right temporal collection (arrow). (B) Axial bone window shows nondisplaced squamous temporal bone fracture (arrow). (C) Coronal soft tissue window shows lenticular hematoma (arrow) with leftward shift (arrowhead).

Severe headaches can be seen with various conditions including intracranial hemorrhage, infection, tumors, stroke, seizure, migraine, and autoimmune conditions.