Epidural Hematoma

What Is It?

An epidural hematoma is a mass of blood in the space between the inner table of the skull and the dura mater (the leathery outer covering of the brain). Typically caused by traumatic brain injury, the bleeding into the epidural space can cause pressure on the brain which can lead to neurological symptoms including coma and death if severe enough.

The epidural space is the area between the inner part of the skull and the dura, "on top of" the dura. Normally, there is no space between these structures. However, with some head injuries, the blood vessels of the dura in this area can become torn and bleed. The bleeding fills this space, separating the bone from the dura. As the hematoma enlarges, it can push on the brain beneath, causing compression and shifting of the brain which can cause neurological symptoms.

While an epidural hematoma can certainly occur with more severe head injury, they can also occur with relatively mild injuries, particularly if they are in the temporal area and cause a fracture of the bone of the skull. The fracture can tear blood vessels in this area, leading to the hematoma.

What Types of Symptoms Are Typical?

An epidural hematoma's presentation varies depending on several factors, most notably the size of the hemorrhage. While patients with smaller bleeds can be asymptomatic or only have headache, larger hematomas can cause significant pressure on the underlying brain. This pressure can lead to a depressed level of consciousness, from confusion and lethargy to coma and death. The level of consciousness and coma in an acutely head injured patient is often described by clinicians with the Glasgow Coma Scale.

Pressure on one side of the brain, causing shift of the brain from one side to the other, can often cause changes in the pupils of the eyes, called a "blown" pupil or fixed and dilated pupil on the side of the hematoma. This only occurs in larger hemorrhages and can be caused by other masses that occur on one side such as a subdural hematoma.

How Is The Diagnosis Typically Made?

While the physical examination can suggest a traumatic hemorrhage, the diagnosis of epidural hematoma is typically made on a CT scan of the brain. This imaging study can show acute blood with a characteristic location and shape. While some patients can have multiple bleeds which make exact diagnosis difficult. A pure epidural is often straightforward to diagnose on a CT.

What Are Some Common Treatments?

The treatment plan for epidural hematoma depends on several factors, most notably the size of the hematoma, the other traumatic injuries, and the clinical condition of the patient. While asymptomatic patients will just be watched closely, more severe cases will often be taken to surgery. The goal of surgery is to remove the hematoma (the blood in the epidural space) and to stop any ongoing bleeding in that area.

Each case is different so each patient or patient's family should discuss the treatment options with their physicians. Oftentimes, in the case of trauma, these patients are taken on an emergent basis to the operating room if their clinical condition is poor.

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Important Note: This site is not intended to offer medical advice. Every patient is different, and only your personal physician can help to counsel you about what is best for your situation. What we offer is general reference information about various disorders and treatments for your education.

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