شاب عمره ٢٢ سنة ضُرب على صدغه الأيمن بكرة بيسبول، فقد الوعي دقائق ثم صحا وكان يتكلم طبيعياً ورفض الذهاب للمستشفى. بعد ساعتين صار نعساناً جداً، وحدقته اليمنى متوسعة، والضغط ١٦٨/٨٠، والنبض ٥٨. ما الأرجح؟

A 22-year-old was struck on the right temple by a baseball, lost consciousness for minutes, then woke and talked normally and refused hospital. Two hours later he is very drowsy with a dilated right pupil, BP 168/80, HR 58. What is most likely?

1. A chronic subdural haematoma
2. A post-traumatic tension headache
3. Extradural (epidural) haematoma
4. A simple concussion needing rest

Answer: C) Extradural (epidural) haematoma. A lucid interval followed by rapid deterioration is classic for extradural haematoma, usually from middle meningeal artery tear with a temporal fracture. It needs urgent imaging and surgery.