Epidural or extradural hematoma (Extradural hemorrhage, Epidural hemorrhage) 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. Between 15 and 20% of epidural hematomas are fatal.
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. The majority of bleeds originate from meningeal arteries, particularly in the temporal region. Ten percent of epidural bleeds may be venous, 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. Thus only 20 to 30% of epidural hematomas occur outside the region of the temporal bone. 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 contrecoup injury. Epidural hematomas may occur in combination with subdural hematomas, or either may occur alone. CT scans reveal subdural or epidural hematomas in 20% of unconscious patient.
A health care provider should be consulted for any head injury that results in even a brief loss of consciousness or if there are any other symptoms after a head injury (even without loss of consciousness).
The typical pattern of symptoms that indicate an epidural hemorrhage is loss of consciousness, followed by alertness, then loss of consciousness again. But this pattern may NOT appear in all people. The neurological examination may indicate that a specific part of the brain is malfunctioning (for instance, arm weakness on one side) or may indicate increased intracranial pressure. If there is increased intracranial pressure, emergency surgery may be needed in order to relieve the pressure and prevent further brain injury. A head CT scan will confirm the diagnosis of an epidural hemorrhage and will pinpoint the exact location of the hematoma and any associated skull fracture.
The symptoms usually occur within minutes to hours after a head injury and indicate an emergency situation.
The most important symptoms of epidural hemorrhage are:
Head injury or trauma followed by loss of consciousness, a period of alertness, then rapid deterioration back to unconsciousness.
Nausea and/or vomiting are symptoms of epidural hemorrhage and often caused by a skull fracture during childhood or adolescence. This type of bleeding is more common in young people because the membrane covering the brain is not as firmly attached to the skull as it is in older people.
An epidural hemorrhage occurs when there is a rupture of a blood vessel, usually an artery, which then bleeds into the space between the "Dura mater" and the skull. The affected vessels are often torn by skull fractures.
This is most often the result of a severe head injury, such as those caused by motorcycle or automobile accidents. Epidural hemorrhages can be caused by venous (from a vein) bleeding in young children.
Rapid bleeding causes a collection of blood (hematoma) that presses on the brain, causing a rapid increase of the pressure inside the head (intracranial pressure). This pressure may result in additional brain injury.
An epidural hemorrhage is an emergency because it may lead to permanent brain damage and death if left untreated. There may be a rapid worsening within minutes to hours, from drowsiness to coma and death.
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 may occur alone. CT scans reveal subdural or epidural hematomas in 20% of unconscious patients. 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.
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. 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.
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. 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. An extradural hemorrhage has a high risk of death without prompt surgical intervention. Even with prompt medical attention, a significant risk of death and disability remains.
There is a risk of permanent brain injury whether the disorder is treated or untreated. Symptoms (such as seizures) may persist for several months, even after treatment, but in time they usually become less frequent or disappear completely. Seizures may begin as many as two years after the injury.
In adults, most recovery occurs in the first six months, with some improvement over approximately two years. Children usually recover more quickly and completely than adults.
Incomplete recovery is the result of brain damage. Other complications include permanent symptoms (such as paralysis or loss of sensation, which began at the time of the injury), herniation of the brain (which may result in permanent coma), and normal pressure hydrocephalus (excess fluid in the cavities of the brain).
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 equine, 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. 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.
Go to the emergency room or call 911 if symptoms of epidural hemorrhage occur and if emergency symptoms develop after treatment, including:
Spinal injuries often occur with head injuries, so if you must move the person before help arrives, try to keep his or her neck still.
An epidural hemorrhage may not be preventable once a head injury has occurred.
To minimize the risk of head injury, use appropriate safety equipment (such as hard hats, bicycle or motorcycle helmets, and seat belts).
Follow general safety rules, for example, do not dive into water if the water depth is unknown or if rocks may be present. Use appropriate safety precautions in sports, recreation, and work. Drive safely.
On April 17, 2003, at age 72, Dr. Robert Atkins, creator of the Atkins diet, slipped on the ice while walking to work, hitting his head and causing bleeding around his brain. He lost consciousness on the way to the hospital, where he spent two weeks in intensive care. His death certificate states that the cause of death was "blunt impact injury of head with epidural hematoma". On March 18, 2009, actress Natasha Richardson died as a result of an epidural hematoma sustained two days earlier while skiing in Mont-Tremblant, Québec, Canada.[16] Like many patients, she had a lucid interval where she did not exhibit any symptoms until approximately an hour after her fall when she complained of a headache. By the time she reached medical care, the hematoma had already caused significant damage.
On September 5, 2012, Major League Baseball Pitcher Brandon McCarthy was hit by a line drive to the head from Erick Aybar. He was immediately rushed to the hospital where he underwent a 2-hour surgery to relieve pressure on his brain. Although he never lost consciousness and walked off the field, McCarthy suffered an epidural hemorrhage, brain contusion and skull fracture in the accident.
On March 18, 2009, actress Natasha Richardson died as a result of an epidural hematoma sustained two days earlier while skiing in Mont-Tremblant, Québec, Canada. Like many patients, she had a lucid interval where she did not exhibit any symptoms until approximately an hour after her fall when she complained of a headache. By the time she reached medical care, the hematoma had already caused significant damage.
Article by: Wikipedia; Published by: mvpboxing.com
