Epidural hematoma

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at February 26, 2016
StartDiseasesEpidural hematoma

An epidural hematoma is a type of traumatic brain injury that typically causes blood to accumulate between the skull and the dura mater which is the outermost layer of the three meninges or membranes that cover the brain. In some cases, an epidural hematoma may be located in the spine as the central nervous system also has a dura. Epidural hematomas occur as a result of head injury and between 15-20% of all epidural hematomas end in death.

Contents

Definition & Facts

The medical term "epidural" refers to "outside the dura" or the casing of the brain or spine and "hematoma" refers to a build-up of blood. Epidural hematomas are sometimes referred to as a brain hemorrhage ('hemorrhage' being a medical term for uncontrollable bleeding) because epidural hematomas are one type of bleeding that occurs in the brain after a person is injured.

Epidural hematomas form very rapidly, usually after trauma to the brain (or spine) because the arteries are under high pressure. As the bleeding increases, epidural hematomas put pressure on the brain, causing the brain to become flattened against the side of the skull.

In some rare cases, epidural hematomas can begin spontaneously without any known damage to the head or spine. Most spontaneous cases occur in young children due to a vein starting to bleed in the area. Epidural hematomas are more common in young people because the dura has not yet become completely attached to the skull.

Symptoms & Complaints

After a significant head injury, there may be a short period of time where the person does not feel any pain or any symptoms followed by a rapid onset of an extremely painful headache as well as physical symptoms.

People with epidural hematomas may show eye damage on the opposite side of the head injury, including eyes that are bulging out and/or pointing downward. There may be other symptoms as well, including a loss of power in the hands and feet on the opposite side of the head injury. Common indicators of an epidural hematoma include:

Causes

When the brain (or spine) undergoes trauma, the internal lining of the skull (or spine), tissues, and blood vessels can rupture. The resulting bleeding has nowhere to go and so begins to build up between the dura and the skull (or spinal column). As the blood begins to rapidly pool, it adds pressure on the brain (or spinal column) leading to vision problems and speech problems as well as a loss of consciousness.

As epidural hematomas are almost always caused by a traumatic injury to the brain (or a spinal injury), they are usually inferred as a secondary result of the brain (or spine) injury itself. Left untreated, epidural hematomas rapidly progress from a severe headache to drowsiness, a coma, and then death within hours or possibly even minutes.

In adults, the most common cause of a traumatic brain injury (often a skull fracture) that leads to an epidural hematoma is being involved in a car or motorcycle accident. People consuming medications like blood thinners or aspirin are more susceptible to developing an epidural hematoma if they receive an injury to the head or spine. Spinal epidural hematomas are more rare than brain hemorrhages but can occur as the result of giving birth, complications with the administration of an epidural (anesthesia injected into the spine) or some types of surgery.

Diagnosis & Tests

If an epidural hematoma is suspected, doctors will perform a neurological examination looking for any weakness or problem on one side of the body as well as elevated levels of intracranial pressure. The standard test for identifying an epidural hematoma is a CT scan or MRI. An MRI can locate the exact placement of any hematomas as well as diagnose any related brain damage.

For spinal epidural hematomas, muscle weakness and bowel dysfunction are known symptoms. Doctors will have to perform a CT scan or MRI of the area in order to identify the presence of an epidural hematoma in the spine.

Treatment & Therapy

Any brain (or spinal) hemorrhage is a severe condition and should be treated immediately in an emergency room. If an epidural hematoma is diagnosed, surgeons will intervene immediately by drilling a small hole in the skull and removing the blood to reduce pressure on the brain. Similarly, spinal epidural hematomas are treated by surgical intervention to remove excess blood and reduce pressure on the spinal column. A craniotomy may be necessary to remove blood clots.

People who receive surgical intervention right after receiving a head injury have a better chance of survival and recovering from an epidural hematoma but there is a significant risk for permanent brain damage even with prompt medical attention. For survivors, doctors may prescribe a course of medication and therapy to address any symptoms of brain damage or other injury that results from having an epidural hematoma. Seizures, for example, are a common complication from epidural hematoma and may require anticonvulsant medications to manage.

Prevention & Prophylaxis

Wearing a helmet, using a seatbelt, and taking other safety precautions when operating or a passenger in a motor vehicle, bicycle, or motorcycle is the best way to prevent traumatic head injuries. People participating in sports activities that could conceivably result in a bad fall and people working on construction sites are recommended to wear a helmet or hard hat to prevent head injuries that can lead to an epidural hematoma.

Once a head or spinal injury has occurred, there is little that can be done to prevent an epidural hematoma. The best course of action is to keep the injured person still without moving their neck. Immediately take the person to the emergency room or summon medical help if a head injury occurs that is accompanied by severe headaches, a loss of consciousness (even briefly), convulsions, enlarged pupils, difficulty breathing, or abnormal lethargy.