دکتر امیررضا برومند

Epidural hematoma

What is an epidural hematoma?

Epidural hematoma or epidural bleeding is when bleeding occurs between the outer membrane of the dura mater of the brain (dura mater) and the skull. This injury often occurs after a blow to the head, loss of consciousness, brief return to consciousness, and then loss of consciousness again. Other symptoms may include headache, confusion, vomiting, and inability to move parts of the body (total paralysis). Complications may include seizures.

Cause of epidural hematoma

The cause is usually head trauma that leads to a fracture of the temporal bone and bleeding from the middle meningeal artery. Sometimes it can occur as a result of a blood coagulation disorder or a blood vessel abnormality. Diagnosis is usually by CT scan or MRI. When this condition occurs in the spine, it is known as spinal epidural hematoma. Epidural hematoma

All skull fractures are accompanied by a small epidural hematoma, which is usually a venous hematoma and originates from the diploic space. When a part of the dura adjacent to the fracture separates from the inner skull, the resulting space is filled with bleeding from the torn mengeal artery, the dura moves further and a large extradural mass is formed, which causes severe pressure on the brain tissue.
Sometimes the above space is filled with venous blood, which is often the case in fractures on the transverse or upper sagittal sinuses.
The cause is the rupture of the upper sinuses or the rupture of the veins that flow into the upper sinuses.
Epidural hematoma can also occur after a mild brain injury.

After the trauma, in a period of time, the functional basics of the brain are normal, and then, with the spread of the epidural hematoma, consciousness is progressively lost and neurological defects appear. The most common place of epidural hematoma is the outer parts of the temporal lobes – where there is a thin skull and numerous meningeal vessels.
With the expansion of the hematoma, the temporal lobe is compressed inward and causes hemiparesis on the opposite side and even transtentorial hernia due to the pressure of the temporal lobe on the midbrain structures towards the tentorial cut.
The mortality rate of epidural hematoma reaches 30 to 50%. These cases especially include patients who have been diagnosed with intracranial hematoma with a delay.
Extradural hematomas may be seen in the posterior cavity, and the most reliable way to diagnose them is CT scan or vertebral angiography.

Treatment is generally immediate surgery in the form of craniotomy or drilling. Without treatment, death usually occurs. This complication occurs in one to four percent of head injuries. It usually occurs in young adults. Men are more often affected than women.

Symptoms of epidural brain hemorrhage

Patients are usually conscious for some time between the shock and the first time they lose consciousness. After that, the person’s mental state slowly declines.

General symptoms are usually headache, nausea and vomiting. Seizures and obvious neurological problems are also possible.

Spinal epidural hematomas are usually associated with severe back pain in a specific area and sometimes cause weakness, numbness, or inability to control the bladder and stool.

The symptoms of subdural hematoma depend on its location and growth rate. Some people remain conscious after this injury, but others’ condition worsens over time and as the bleeding worsens.

Diagnosis of epidural brain hemorrhage

Epidural hematoma can be diagnosed with medical tests. Usually, head scans such as CT scan without contrast are used to observe skull fractures and the epidural hematoma itself.

An epidural hematoma can also be clearly seen with MRI scans, but this test is probably not suitable for patients who are unstable.

Toxicology and blood alcohol testing are done to rule out other possible causes.

In suspected cases of acute subdural hematoma, an emergency CT scan of the head should be performed (of course, after stabilization of the patient’s condition).

Non-contrast CT scans also help in diagnosis. Drug and alcohol testing are also optional tests to rule out other possible causes.

Treatment of epidural hemorrhage of the brain

The main method of treating this disease is to perform a brain surgery. However, in cases where the bleeding does not exceed 20-50 ml, brain hematoma can be treated without surgery.

For this, there should be no signs of tissue compression in the patient’s brain.

Epidural hematoma is a surgical emergency. A delay in surgery can lead to permanent brain damage or death.

Failure to perform surgery will usually lead to death due to hematoma enlargement and brain herniation.

As with other types of intracranial hematoma, the blood must be surgically removed in almost all cases to relieve pressure on the brain.

The hematoma is drained through an incision or craniotomy. If transfer to a neurosurgery center is not possible, drilling (creating a hole in the skull) is likely to be done in the emergency department.

Open craniotomy will be required for hematomas and large blood clots.

Usually, after surgery, drugs such as anticonvulsants and hyperosmotic drugs are prescribed to reduce brain swelling and intracranial pressure.

A case that does not require surgery is very rare.

If there are no visible neurological symptoms and the volume of the epidural hematoma is less than 30 ml, the clot diameter is less than 15 mm, and the Glasgow Coma Scale is greater than 8, it may be possible to treat conservatively.

A CT scan should be performed and the patient should be observed for some time, because there is a possibility of sudden development of hemorrhage.

Subdural hematoma treatment will be based on severity and cause. In severe cases, resuscitation is necessary. Emergency surgery (decompression surgery) may be performed.

If the patient’s coma scale is at a certain level, they will often need help to breathe.

Clinical manifestations of brain epidural hemorrhage

The clinical manifestations of epidural hematoma are characterized by the rapid development of a so-called clear interval, which is characterized by the recovery of part of the neurological functions and primarily the patient’s return to consciousness.

Meanwhile, other symptoms remain, such as dizziness of varying severity, general weakness, headache, and mental problems.

Scroll to Top