Epidural Hematoma: Symptoms and Treatment

Overview

Epidural hematoma, also known as an extradural
hematoma, refers to the pooling blood between the inner surface of your skull
and the protective covering of your brain. Immediate interventions are needed
because an epidural hematoma can lead to lasting brain damage and even death, if
left untreated.

Epidural hematoma is often caused by a history
of head trauma and frequent skull fracture. In addition, epidural hematoma can cause
your brain to swell and affect your vision, speech, mobility, and
consciousness. In this situation, direct neurosurgical care plays an important
role in recognizing and controlling the blood.

More
importantly, as a common head disease, an epidural hematoma occurs in 2% of all
head injuries and up to 15% of all fatal head traumas.

Adolescents and young adults have the highest incidence compared with other groups of people.

Causes

Epidural hematoma has many causes. And some of them include:

  • A skull fracture during childhood or adolescence

For
young people, their membrane covering the brain is not so closely attached to
the skull, so this type of bleeding may occur.

  • Skull fractures
    of severe head injury or trauma

Some activities or events can cause skull fractures, leading to an
epidural hematoma, including a contact sport like football or rugby, automobile
accidents, falling from a ladder, physical abuse and a violent attack

  • Rupture of a blood
    vessel

If a blood vessel ruptures, usually an artery, it bleeds into the space
between the dura and the skull.

  • Surgeries

Any sort of surgeries, invasive medical or dental procedures, such as biopsies, incision and drainage, cardiac catheterization, will cause epidural hematoma.

  • Certain medical
    conditions

Individuals with chronic liver disease, excessive alcohol use, bleeding disorders, and blood cancers are more likely to have hematomas.

  • Medications

Certain blood thinner medications, some common medications and supplements like vitamin E and nonsteroidal anti-inflammatory drugs can increase the risk of hematoma formation.

Symptoms

An epidural
hematoma’s presentation varies depending on several factors, most notably the
size of the hemorrhage. Some of the most common symptoms include:

  • vomiting
  • nausea
  • dizziness
  • confusion
  • lethargy
  • coma
  • seizures
  • loss of vision on one side
  • changes in breathing
  • severe headache
  • weakness in one side of the body
  • enlarged pupil in one eye
  • drowsiness or loss of alertness

Diagnosis

Examination of a hematoma includes a physical inspection along with a comprehensive medical history.

However, depending on the situation, a variety of tests including complete blood count (CBC), coagulation panel, chemistry and metabolic panel, and liver tests may be conducted for further diagnosis.

Imaging techniques
are also needed to determine the position and size of a hematoma. These
include:

  • CT scan
  • MRI scan
  • Angiogram

Treatment

For some small hematomas without obvious symptoms,
medical treatment may not be necessary. However, to prevent it from relapsing,
you have to be watched for neurological changes, have your intracranial
pressure monitored and undergo repeated head CT scans. Vitamin K and fresh
frozen plasma are opted to reverse blood thinners such as warfarin.

For other hematomas that produce symptoms or appear
in certain locations, medical or surgical treatment is required.

Surgery

  • Craniotomy

In this procedure, part of the skull is
removed temporarily to remove several hematomas.

  • Aspiration

When the epidural hematoma is smaller or less
severe, a doctor will likely recommend aspiration. Aspiration involves drilling
a small hole in the skull.

Medications

Prior to surgery, a person will require hyperosmotic agents to help reduce inflammation and swelling in the brain, including:

After surgery, a doctor will likely prescribe
anti-seizure medications. And these drugs may be taken for a long time after the
injury.

Keywords: epidural hematoma.

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