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|eMedicine_mult = {{eMedicine2|med|2898}} {{eMedicine2|neuro|574}}}}
 
|eMedicine_mult = {{eMedicine2|med|2898}} {{eMedicine2|neuro|574}}}}
   
'''Epidural''' or '''extradural hematoma''' is a buildup of blood occurring between the [[dura mater]] (the [[brain|brain's]] tough outer membrane) and the [[skull]]. Often due to [[head trauma|trauma]], the condition is potentially deadly because the buildup of blood may increase [[intracranial pressure|pressure]] in the [[intracranial space]] and compress delicate brain tissue. 15 to 20% of patients with epidural hematomas die of the [[injury]].<ref>Sanders MJ and McKenna K. 2001. ''Mosby’s Paramedic Textbook'', 2nd revised Ed. Chapter 22, "Head and Facial Trauma." Mosby.</ref>
+
{{Infobox disease
  +
| Name = Epidural hematoma
  +
| Image = Epidural_Hematoma.jpg
  +
| Caption = Epidural hematoma. Note the biconvex shape hemorrhage.
  +
| ICD10 = {{ICD10|I|62|1|i|60}}, {{ICD10|S|06|4|s|00}}
  +
| ICD9 = {{ICD9|432.0}}
  +
| DiseasesDB = 4353
  +
| MedlinePlus = 001412
  +
| eMedicineSubj = emerg
  +
| eMedicineTopic = 167
  +
| eMedicine_mult = {{eMedicine2|med|2898}} {{eMedicine2|neuro|574}}
  +
| MeshID = D006407
  +
}}
  +
'''Epidural''' or '''extradural hematoma (haematoma)''' is a type of [[traumatic brain injury]] (TBI) in which a buildup of blood occurs between the [[dura mater]] (the tough outer membrane of the [[central nervous system]]) and the [[Human skull|skull]]. The dura mater also covers the spine, so epidural bleeds may also occur in the spinal column. Often due to [[physical trauma|trauma]], the condition is potentially deadly because the buildup of blood may increase [[intracranial pressure|pressure]] in the [[intracranial space]], compress delicate brain tissue, and cause [[brain herniation|brain shift]]. The condition is present in one to three percent of [[head injury|head injuries]].<ref name="Mishra">{{cite journal|author=Mishra A, Mohanty S|title=Contre-coup extradural haematoma: A short report|journal=Neurology India|volume=49|issue=94|url=http://www.neurologyindia.com/article.asp?issn=0028-3886;year=2001;volume=49;issue=1;spage=94;epage=5;aulast=Mishra|accessdate=2008-01-24|pmid=11303253|pages=94|year=2001}}</ref> Between 15 and 20% of epidural hematomas are fatal.<ref>Sanders MJ and McKenna K. 2001. ''Mosby’s Paramedic Textbook'', 2nd revised Ed. Chapter 22, "Head and Facial Trauma." Mosby.</ref>
   
==Causes==
+
==Signs and symptoms==
The cause of epidural hematoma is usually [[brain trauma|traumatic]], although spontaneous hemorrhage is known to occur. Hemorrhages commonly result from [[acceleration-deceleration trauma]] and transverse forces.<ref name="uv">University of Vermont College of Medicine. [http://web.archive.org/web/20050309165318/http://cats.med.uvm.edu/cats_teachingmod/pathology/path302/np/home/neuroindex.html "Neuropathology: Trauma to the CNS."] Accessed through web archive. Retrieved on [[February 6]], [[2007]].</ref><ref name="McCaffrey">McCaffrey P. 2001. [http://www.csuchico.edu/~pmccaff/syllabi/SPPA336/336unit11.html "The Neuroscience on the Web Series: CMSD 336 Neuropathologies of Language and Cognition."] California State University, Chico. Retrieved on [[February 6]], [[2007]].</ref> [[vein|Venous]] epidural bleeds are usually due to [[shearing injury]] from [[angular momentum|rotational]] or linear forces, caused when tissues of different densities slide over one another.
+
Epidural bleeds, like [[subdural hematoma|subdural]] and [[subarachnoid hemorrhage]]s, are [[extra-axial hemorrhage|extra-axial bleeds]], occurring outside of the brain tissue, while [[intra-axial hemorrhage]]s, including [[intraparenchymal hemorrhage|intraparenchymal]] and [[intraventricular hemorrhage]]s, occur within it.
   
Epidural hematoma commonly results from a blow to the side of the head and is frequently caused by a fracture that passes through an arterial channel in the [[bone]], most commonly a break in [[temporal bone]] interrupting [[middle meningeal artery]], a branch of the [[external carotid]].<ref name="Shepherd">Shepherd S. 2004. [http://www.emedicine.com/med/topic2820.htm "Head Trauma."] Emedicine.com. Retrieved on [[February 6]], [[2007]].</ref> Thus only 20 to 30% of epidural hematomas occur outside the region of the temporal bone.<ref>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.</ref>
+
Epidural hematomas may present with a lucid period immediately following the trauma and a delay before symptoms become evident. After the epidural hematoma begins collecting, it starts to compress intracranial structures which may impinge on the CN III.<ref name=medscape/> This can be seen in the physical exam as a fixed and dilated pupil on the side of the injury.<ref name=medscape>[http://emedicine.medscape.com/article/824029-overview#a0104 Epidural Hematoma in Emergency Medicine] at Medscape. Author: Daniel D Price. Updated: Nov 3, 2010</ref> The eye will be positioned down and out, due to unopposed CN IV and CN VI innervation.
   
==Features==
+
Other manifestations will include weakness of the extremities on the opposite side as the lesion (except in rare cases), due to compression of the [[Pyramidal tracts|crossed pyramid pathways]], and a loss of visual field opposite to the side of the lesion, due to compression of the [[posterior cerebral artery]] on the side of the lesion.
Epidural bleeds, like [[subdural hematoma|subdural]] and [[subarachnoid hemorrhage]]s, are [[extra-axial hemorrhage|extra-axial bleeds]], occurring outside of the brain tissue, while [[intra-axial hemorrhage]]s, including [[intraparenchymal hemorrhage|intraparenchymal]] and [[intraventricular hemorrhage]]s, occur within it.<ref>Wagner AL. 2006. [http://www.emedicine.com/radio/topic664.htm "Subdural Hematoma."] Emedicine.com. Retrieved on [[February 6]], [[2007]].</ref>
 
   
Epidural bleeding is rapid because it is usually from arteries, which are high pressure. Epidural bleeds from arteries can grow until they reach their peak size at six to eight hours post injury, spilling from 25 to 75 [[cubic centimeter]]s of blood into the [[intracranial space]].<ref name="uv"/> As the hematoma expands, it strips the dura from the inside of the skull, causing an intense headache.
+
The most feared event that takes place is the transtentorial, or uncal herniation which results in respiratory arrest since the medullary structures are compromised. The trigeminal nerve (CN V) may be involved late in the process as the pons becomes compressed, but this is not a significant clinical presentation, since by that time the patient may already be dead.<ref>Wagner AL. 2006. [http://www.emedicine.com/radio/topic664.htm "Subdural Hematoma."] Emedicine.com. Retrieved on February 6, 2007.</ref> In the case of epidural hematoma in the [[posterior cranial fossa]], the herniation is [[Brain herniation#Tonsillar herniation|tonsillar]] and causes the [[Cushing's triad]]: hypertension, bradycardia, and irregular respiration.
   
Epidural bleeds can become large and raise [[intracranial pressure]], causing the brain to shift, lose blood supply, or be crushed against the skull. Larger hematomas cause more damage. Epidural bleeds can quickly expand and compress the brain stem, causing [[coma|unconsciousness]], [[abnormal posturing]], and abnormal [[pupil]] responses to light.<ref name="singh Stock">Singh J and Stock A. 2006. [http://www.emedicine.com/ped/topic929.htm "Head Trauma."] Emedicine.com. Retrieved on [[February 6]], [[2007]].</ref>
+
Epidural bleeding is rapid because it is usually from arteries, which are high pressure. Epidural bleeds from arteries can grow until they reach their peak size at six to eight hours post injury, spilling from 25 to 75 cubic centimeters of blood into the [[intracranial space]].<ref name="uv"/> As the hematoma expands, it strips the dura from the inside of the skull, causing an intense headache. Epidural bleeds can become large and raise [[intracranial pressure]], causing the brain to shift, lose blood supply, or be crushed against the skull. Larger hematomas cause more damage. Epidural bleeds can quickly expand and compress the brain stem, causing [[coma|unconsciousness]], [[abnormal posturing]], and abnormal [[pupil]] responses to light.<ref name="singh Stock">Singh J and Stock A. 2006. [http://www.emedicine.com/ped/topic929.htm "Head Trauma."] Emedicine.com. Retrieved on February 6, 2007.</ref>
   
10% of epidural bleeds may be venous.<ref name="Shepherd"/>
+
==Diagnosis==
  +
{{Epidural vs. subdural hematoma}}
  +
On images produced by [[CT scan]]s and [[MRI]]s, epidural hematomas usually appear convex in shape because their expansion stops at the skull's [[skull suture|sutures]], where the dura mater is tightly attached to the skull. Thus they expand inward toward the brain rather than along the inside of the skull, as occurs in [[subdural hematoma]]. The lens-like shape of the hematoma causes the appearance of these bleeds to be "lentiform."
   
On images produced by [[CT scan]]s and [[MRI]]s, epidural hematomas usually appear convex in shape because their expansion stops at skull's [[skull suture|sutures]], where the dura mater is tightly attached to the skull. Thus they expand inward toward the brain rather than along the inside of the skull, as occurs in [[subdural hematoma]]. The lens like shape of the hematoma leads the appearance of these bleeds to be called "lentiform".
+
Epidural hematomas may occur in combination with subdural hematomas, or either may occur alone.<ref name="Shepherd"/> CT scans reveal subdural or epidural hematomas in 20% of unconscious patients.<ref name="Downie">Downie A. 2001. [http://www.radiology.co.uk/srs-x/tutors/cttrauma/tutor.htm "Tutorial: CT in Head Trauma"]. Retrieved on February 6, 2007.</ref> In the hallmark of epidural hematoma, patients may regain consciousness and appear completely normal during what is called a [[lucid interval]], only to descend suddenly and rapidly into unconsciousness later. The lucid interval, which depends on the extent of the injury, is a key to diagnosing epidural hemorrhage. If the patient is not treated with prompt surgical intervention, death is likely to follow.<ref name="Caroline">Caroline NL. 1991. ''Emergency Medical Treatment''. Little Brown & Company.</ref>
   
Epidural hematomas may occur in combination with subdural hematomas, or either may occur alone.<ref name="Shepherd"/> CT scans reveal subdural or epidural hematomas in 20% of unconscious patients.<ref name="Downie">Downie A. 2001. [http://www.radiology.co.uk/srs-x/tutors/cttrauma/tutor.htm "Tutorial: CT in Head Trauma"]. Retrieved on [[February 6]], [[2007]].</ref>
+
==Causes==
  +
[[Image:Skull interior anatomy.svg|thumb|The interior of the skull has sharp ridges by which a moving brain can be injured]]
   
In the hallmark of epidural hematoma, patients may regain consciousness during what is called a [[lucid interval]], only to descend suddenly and rapidly into unconsciousness later. The lucid interval, which depends on the extent of the injury, is a key to diagnosing epidural hemorrhage. If the patient is not treated with prompt surgical intervention, death is likely to follow.<ref name="Caroline">Caroline NL. 1991. ''Emergency Medical Treatment''. Little Brown & Company.</ref>
+
The most common cause of intracranial epidural hematoma is [[Traumatic brain injury|traumatic]], although spontaneous hemorrhage is known to occur. Hemorrhages commonly result from acceleration-deceleration trauma and transverse forces.<ref name="uv">University of Vermont College of Medicine. [http://web.archive.org/web/20050309165318/http://cats.med.uvm.edu/cats_teachingmod/pathology/path302/np/home/neuroindex.html "Neuropathology: Trauma to the CNS."] Retrieved on February 6, 2007.</ref><ref name="McCaffrey">McCaffrey P. 2001. [http://www.csuchico.edu/~pmccaff/syllabi/SPPA336/336unit11.html "The Neuroscience on the Web Series: CMSD 336 Neuropathologies of Language and Cognition."] California State University, Chico. Retrieved on February 6, 2007.</ref> The majority of bleeds originate from [[meningeal artery|meningeal arteries]], particularly in the [[temple (anatomy)|temporal region]]. 10% of epidural bleeds may be [[vein|venous]],<ref name="Shepherd"/> due to shearing injury from [[angular momentum|rotational]] forces. Epidural hematoma commonly results from a blow to the side of the head. The [[pterion]] region which overlies the middle meningeal artery is relatively weak and prone to injury.<ref name="Shepherd">Shepherd S. 2004. [http://www.emedicine.com/med/topic2820.htm "Head Trauma."] Emedicine.com. Retrieved on February 6, 2007.</ref> Thus only 20 to 30% of epidural hematomas occur outside the region of the temporal bone.<ref>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.</ref> The brain may be injured by prominences on the inside of the skull as it scrapes past them. Epidural hematoma is usually found on the same side of the brain that was impacted by the blow, but on very rare occasions it can be due to a [[contrecoup injury]].<ref name="Mishra"/>
   
 
==Treatment==
 
==Treatment==
As with other types of [[intracranial hematoma]]s, the blood may be aspirated surgically to remove the mass and reduce the pressure it puts on the brain.<ref name="McCaffrey"/> The hematoma is [[neurosurgery|neurosurgically]] evacuated through a [[burr hole]] or [[craniotomy]]. The diagnosis of epidural hematoma requires a patient to be cared for in a facility with a neurosurgeon on call to decompress the hematoma if necessary and stop the bleed by ligating the injured vessel branches.
+
As with other types of [[intracranial hematoma]]s, the blood may be removed surgically to remove the mass and reduce the pressure it puts on the brain.<ref name="McCaffrey"/> The hematoma is evacuated through a [[burr hole]] or [[craniotomy]]. If transfer to a facility with neurosurgery is prolonged [[trephination]] may be performed in the emergency department.<ref>{{cite journal|author=Smith SW, Clark M, Nelson J, Heegaard W, Lufkin KC, Ruiz E|title=Emergency department skull trephination for epidural hematoma in patients who are awake but deteriorate rapidly|journal=J Emerg Med|volume=39|issue=3|pages=377–83|year=2010|pmid=19535215 |doi=10.1016/j.jemermed.2009.04.062}}</ref>
   
==Epidural hematoma in the spine==
+
==Prognosis==
Bleeding into the epidural space in the spine may also cause epidural hematoma. These may arise spontaneously (e.g. during [[childbirth]], or as a rare complication of anaesthesia (such as [[epidural]] anaesthesia) or surgery (such as laminectomy).
+
In TBI patients with epidural hematomas, prognosis is better if there was a lucid interval (a period of consciousness before coma returns) than if the patient was comatose from the time of injury.<ref name="Zink01"/> Unlike most forms of TBI, people with epidural hematoma and a [[Glasgow Coma Score]] of 3 (the lowest score) are expected to make a good outcome if they can receive surgery quickly.<ref name="Zink01">{{cite journal|author=Zink BJ|title=Traumatic brain injury outcome: Concepts for emergency care|journal=Ann Emerg Med|volume=37|issue=3|pages=318–32|year=2001|pmid=11223769|doi=10.1067/mem.2001.113505 }}</ref>
   
The anatomy of the epidural space means that spinal epidural hematoma has a different profile from cranial epidural hematoma. In the spine, the epidural space contains loose fatty tissue, and the '''epidural venous plexus''', a network of large, thin-walled veins. This means that bleeding is likely to be venous. Anatomical abnormalities and [[coagulopathy| bleeding disorder]]s make these lesions more likely.
+
==Of the spine==
  +
Bleeding into the epidural space in the spine may also cause epidural hematoma. These may arise spontaneously (e.g. during [[childbirth]]), or as a rare complication of anaesthesia (such as [[epidural]] anaesthesia) or surgery (such as [[laminectomy]]).
   
They may cause pressure on the spinal cord or [[cauda equina]], which may present as pain, muscle weakness, or bladder and bowel dysfunction.
+
The anatomy of the epidural space means that spinal epidural hematoma has a different profile from cranial epidural hematoma. In the spine, the epidural space contains loose fatty tissue, and the '''epidural venous plexus''', a network of large, thin-walled veins. This means that bleeding is likely to be venous. Anatomical abnormalities and [[coagulopathy|bleeding disorders]] make these lesions more likely. They may cause pressure on the spinal cord or [[cauda equina]], which may present as pain, muscle weakness, or bladder and bowel dysfunction. The diagnosis may be made on clinical appearance and time course of symptoms. It usually requires [[MRI]] scanning to confirm. The treatment is surgical decompression.{{Citation needed|date=June 2011}} The incidence of epidural hematoma following epidural anaesthesia is extremely difficult to quantify; estimates vary from 1 per 10,000 to 1 per 100,000 epidural anaesthetics.
 
The diagnosis may be made on clinical appearance and time course of symptoms. It usually requires [[MRI]] scanning to confirm.
 
 
The treatment is surgical decompression.
 
 
The incidence of epidural hematoma following epidural anaesthesia is extremely difficult to quantify; estimates vary from 1 per 10,000 to 1 per 100,000 epidural anaesthetics. This means that a typical anaesthetist or [[anesthesiologist]] is statistically unlikely to cause one in a whole career.
 
 
==Trivia==
 
 
The character of [[Pavel Chekov]] suffers from an epidural hematoma in the movie [[Star Trek IV]]. The physician states to [[Leonard McCoy]] that "an evacuation of the expanding epidural hematoma will relieve the pressure!" to which McCoy answers that drilling holes in the head is not the answer and that the correct solution is to repair the ruptured [[artery]].
 
   
 
==See also==
 
==See also==
  +
* [[Brain contusion]]
  +
* [[Cerebral hemorrhage]]
  +
* [[Concussion]]
  +
* [[Diffuse axonal injury]]
 
* [[Intracranial hematoma]]
 
* [[Intracranial hematoma]]
 
:* [[Extra-axial hematoma]]
 
:* [[Extra-axial hematoma]]
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::* [[Subarachnoid hemorrhage]]
 
::* [[Subarachnoid hemorrhage]]
 
:* [[Intra-axial hematoma]]
 
:* [[Intra-axial hematoma]]
* [[Diffuse axonal injury]]
+
* [[Concussion]]
 
* [[Brain contusion]]
 
 
 
==References==
 
==References==
 
<references/>
 
<references/>
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{{Cerebral hemorrhage}}
 
{{Cerebral hemorrhage}}
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  +
[[Category:Cerebral hemorrhage]]
  +
[[Category:Cerebrovascular disorders]]
 
[[Category:Neurotrauma]]
 
[[Category:Neurotrauma]]
 
[[Category:Neurology]]
 
[[Category:Neurology]]
   
:fr:Hématome extra-dural
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:nl:Epidurale bloeding
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:ja:急性硬膜外血腫
+
<!--
  +
[[cs:Epidurální hematom]]
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[[de:Hirnblutung#Epiduralblutung]]
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[[el:Επισκληρίδιο αιμάτωμα]]
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[[es:Hematoma epidural]]
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[[fr:Hématome extra-dural]]
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[[hr:Epiduralni hematom]]
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[[nl:Epidurale bloeding]]
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[[ja:急性硬膜外血腫]]
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[[pl:Krwiak nadtwardówkowy]]
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[[tr:Epidural hematom]]
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-->
 
{{enWP|Epidural hematoma}}
 
{{enWP|Epidural hematoma}}

Latest revision as of 17:02, August 17, 2012

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Epidural hematoma.png|
Extradural haemorrhage
ICD-10 I621, S064
ICD-9 432.0
OMIM [1]
DiseasesDB 4353
MedlinePlus 001412
eMedicine emerg/167 med/2898 neuro/574
MeSH {{{MeshNumber}}}


Epidural hematoma
Classification and external resources
Template:Px
Epidural hematoma. Note the biconvex shape hemorrhage.
ICD-10 I621, S064
ICD-9 432.0
DiseasesDB 4353
MedlinePlus 001412
eMedicine emerg/167 med/2898 neuro/574
MeSH D006407

Epidural or extradural hematoma (haematoma) is a type of traumatic brain injury (TBI) in which a buildup of blood occurs between the dura mater (the tough outer membrane of the central nervous system) and the skull. The dura mater also covers the spine, so epidural bleeds may also occur in the spinal column. Often due to trauma, the condition is potentially deadly because the buildup of blood may increase pressure in the intracranial space, compress delicate brain tissue, and cause brain shift. The condition is present in one to three percent of head injuries.[1] Between 15 and 20% of epidural hematomas are fatal.[2]

Signs and symptomsEdit

Epidural bleeds, like subdural and subarachnoid hemorrhages, are extra-axial bleeds, occurring outside of the brain tissue, while intra-axial hemorrhages, including intraparenchymal and intraventricular hemorrhages, occur within it.

Epidural hematomas may present with a lucid period immediately following the trauma and a delay before symptoms become evident. After the epidural hematoma begins collecting, it starts to compress intracranial structures which may impinge on the CN III.[3] This can be seen in the physical exam as a fixed and dilated pupil on the side of the injury.[3] The eye will be positioned down and out, due to unopposed CN IV and CN VI innervation.

Other manifestations will include weakness of the extremities on the opposite side as the lesion (except in rare cases), due to compression of the crossed pyramid pathways, and a loss of visual field opposite to the side of the lesion, due to compression of the posterior cerebral artery on the side of the lesion.

The most feared event that takes place is the transtentorial, or uncal herniation which results in respiratory arrest since the medullary structures are compromised. The trigeminal nerve (CN V) may be involved late in the process as the pons becomes compressed, but this is not a significant clinical presentation, since by that time the patient may already be dead.[4] In the case of epidural hematoma in the posterior cranial fossa, the herniation is tonsillar and causes the Cushing's triad: hypertension, bradycardia, and irregular respiration.

Epidural bleeding is rapid because it is usually from arteries, which are high pressure. Epidural bleeds from arteries can grow until they reach their peak size at six to eight hours post injury, spilling from 25 to 75 cubic centimeters of blood into the intracranial space.[5] As the hematoma expands, it strips the dura from the inside of the skull, causing an intense headache. Epidural bleeds can become large and raise intracranial pressure, causing the brain to shift, lose blood supply, or be crushed against the skull. Larger hematomas cause more damage. Epidural bleeds can quickly expand and compress the brain stem, causing unconsciousness, abnormal posturing, and abnormal pupil responses to light.[6]

DiagnosisEdit

Template:Epidural vs. subdural hematoma On images produced by CT scans and MRIs, epidural hematomas usually appear convex in shape because their expansion stops at the skull's sutures, where the dura mater is tightly attached to the skull. Thus they expand inward toward the brain rather than along the inside of the skull, as occurs in subdural hematoma. The lens-like shape of the hematoma causes the appearance of these bleeds to be "lentiform."

Epidural hematomas may occur in combination with subdural hematomas, or either may occur alone.[7] CT scans reveal subdural or epidural hematomas in 20% of unconscious patients.[8] In the hallmark of epidural hematoma, patients may regain consciousness and appear completely normal during what is called a lucid interval, only to descend suddenly and rapidly into unconsciousness later. The lucid interval, which depends on the extent of the injury, is a key to diagnosing epidural hemorrhage. If the patient is not treated with prompt surgical intervention, death is likely to follow.[9]

CausesEdit

File:Skull interior anatomy.svg

The most common cause of intracranial epidural hematoma is traumatic, although spontaneous hemorrhage is known to occur. Hemorrhages commonly result from acceleration-deceleration trauma and transverse forces.[5][10] The majority of bleeds originate from meningeal arteries, particularly in the temporal region. 10% of epidural bleeds may be venous,[7] due to shearing injury from rotational forces. Epidural hematoma commonly results from a blow to the side of the head. The pterion region which overlies the middle meningeal artery is relatively weak and prone to injury.[7] Thus only 20 to 30% of epidural hematomas occur outside the region of the temporal bone.[11] The brain may be injured by prominences on the inside of the skull as it scrapes past them. Epidural hematoma is usually found on the same side of the brain that was impacted by the blow, but on very rare occasions it can be due to a contrecoup injury.[1]

TreatmentEdit

As with other types of intracranial hematomas, the blood may be removed surgically to remove the mass and reduce the pressure it puts on the brain.[10] The hematoma is evacuated through a burr hole or craniotomy. If transfer to a facility with neurosurgery is prolonged trephination may be performed in the emergency department.[12]

PrognosisEdit

In TBI patients with epidural hematomas, prognosis is better if there was a lucid interval (a period of consciousness before coma returns) than if the patient was comatose from the time of injury.[13] Unlike most forms of TBI, people with epidural hematoma and a Glasgow Coma Score of 3 (the lowest score) are expected to make a good outcome if they can receive surgery quickly.[13]

Of the spineEdit

Bleeding into the epidural space in the spine may also cause epidural hematoma. These may arise spontaneously (e.g. during childbirth), or as a rare complication of anaesthesia (such as epidural anaesthesia) or surgery (such as laminectomy).

The anatomy of the epidural space means that spinal epidural hematoma has a different profile from cranial epidural hematoma. In the spine, the epidural space contains loose fatty tissue, and the epidural venous plexus, a network of large, thin-walled veins. This means that bleeding is likely to be venous. Anatomical abnormalities and bleeding disorders make these lesions more likely. They may cause pressure on the spinal cord or cauda equina, which may present as pain, muscle weakness, or bladder and bowel dysfunction. The diagnosis may be made on clinical appearance and time course of symptoms. It usually requires MRI scanning to confirm. The treatment is surgical decompression.[citation needed] The incidence of epidural hematoma following epidural anaesthesia is extremely difficult to quantify; estimates vary from 1 per 10,000 to 1 per 100,000 epidural anaesthetics.

See alsoEdit

ReferencesEdit

  1. 1.0 1.1 Mishra A, Mohanty S (2001). Contre-coup extradural haematoma: A short report. Neurology India 49 (94): 94.
  2. Sanders MJ and McKenna K. 2001. Mosby’s Paramedic Textbook, 2nd revised Ed. Chapter 22, "Head and Facial Trauma." Mosby.
  3. 3.0 3.1 Epidural Hematoma in Emergency Medicine at Medscape. Author: Daniel D Price. Updated: Nov 3, 2010
  4. Wagner AL. 2006. "Subdural Hematoma." Emedicine.com. Retrieved on February 6, 2007.
  5. 5.0 5.1 University of Vermont College of Medicine. "Neuropathology: Trauma to the CNS." Retrieved on February 6, 2007.
  6. Singh J and Stock A. 2006. "Head Trauma." Emedicine.com. Retrieved on February 6, 2007.
  7. 7.0 7.1 7.2 Shepherd S. 2004. "Head Trauma." Emedicine.com. Retrieved on February 6, 2007.
  8. Downie A. 2001. "Tutorial: CT in Head Trauma". Retrieved on February 6, 2007.
  9. Caroline NL. 1991. Emergency Medical Treatment. Little Brown & Company.
  10. 10.0 10.1 McCaffrey P. 2001. "The Neuroscience on the Web Series: CMSD 336 Neuropathologies of Language and Cognition." California State University, Chico. Retrieved on February 6, 2007.
  11. 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.
  12. Smith SW, Clark M, Nelson J, Heegaard W, Lufkin KC, Ruiz E (2010). Emergency department skull trephination for epidural hematoma in patients who are awake but deteriorate rapidly. J Emerg Med 39 (3): 377–83.
  13. 13.0 13.1 Zink BJ (2001). Traumatic brain injury outcome: Concepts for emergency care. Ann Emerg Med 37 (3): 318–32.

External linksEdit



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