Epidural Hematoma: Symptoms, Causes, Treatment

What are the symptoms of an epidural hematoma?

An epidural hematoma is a type of traumatic brain injury where bleeding occurs between the outer layer of the brain (dura mater) and the skull. Symptoms of an epidural hematoma can develop rapidly and may include:

Headache: Often severe and may progressively worsen.
Loss of consciousness: Following a period of lucidity after the injury.
Nausea and vomiting: Particularly if accompanied by a headache.
Confusion or disorientation: Difficulty remembering events or confusion about surroundings.
Weakness or numbness: Especially on one side of the body.
Seizures: In some cases, a seizure may occur.
Dizziness or loss of balance: Difficulty walking or standing.
Drowsiness: Feeling excessively sleepy or difficulty staying awake.
Unequal pupil size (anisocoria): One pupil may be larger than the other.
Visual disturbances: Blurred vision or other vision changes.

It’s important to note that symptoms of an epidural hematoma can vary, and not everyone will experience all of these symptoms. If you or someone you know experiences a head injury and develops any of these symptoms, seek immediate medical attention, as an epidural hematoma can be life-threatening if not treated promptly.

What are the causes of an epidural hematoma?

An epidural hematoma is typically caused by a traumatic head injury that results in bleeding between the skull and the dura mater (the outermost membrane surrounding the brain). The most common causes include:

Blunt trauma: Such as a fall, car accident, or sports injury that causes a sudden impact to the head.
Fracture: A skull fracture can tear the middle meningeal artery or vein, leading to bleeding.
Assault: Physical assault or abuse that causes a head injury.
Penetrating injury: A gunshot wound or sharp object that penetrates the skull and damages blood vessels.
Medical procedures: Rarely, epidural hematomas can occur as a complication of surgery or other medical procedures involving the head.
Rare non-traumatic causes: These include conditions such as arteriovenous malformations (AVMs), which are abnormal tangles of blood vessels in the brain that can rupture and bleed.

Epidural hematomas are considered medical emergencies and require prompt treatment to prevent serious complications, including brain damage or death.

How is an epidural hematoma diagnosed?

Diagnosis of an epidural hematoma typically involves a combination of medical history, physical examination, and imaging tests. Here’s how it’s usually diagnosed:

Medical history and physical examination: Your healthcare provider will ask about your symptoms, the circumstances surrounding any head injury, and any other relevant medical history. They will also conduct a physical examination, which may include checking your neurological function, vision, and pupil reactions.
Imaging tests: The primary imaging test used to diagnose an epidural hematoma is a CT (computed tomography) scan of the head. This imaging test can show the presence of a blood clot and its location, size, and effect on the brain. MRI (magnetic resonance imaging) may also be used in some cases.
Neurological assessment: This includes assessing your level of consciousness, muscle strength, coordination, reflexes, and sensation, which can help determine the extent of brain injury.
Monitoring: If an epidural hematoma is suspected but not immediately confirmed, you may be closely monitored in a hospital setting for any changes in symptoms or neurological status.

Prompt diagnosis and treatment are crucial for epidural hematomas, as they can rapidly worsen and lead to serious complications. If you or someone you know experiences a head injury and develops symptoms such as severe headache, confusion, or loss of consciousness, seek immediate medical attention.

What is the treatment for an epidural hematoma?

The treatment for an epidural hematoma typically involves surgical intervention to remove the blood clot and relieve pressure on the brain. The goals of treatment are to stabilize the patient, prevent further brain injury, and minimize long-term complications. Treatment steps may include:

Emergency medical care: If you suspect an epidural hematoma, seek immediate medical attention. Emergency medical personnel can stabilize the patient and transport them to the hospital.
Diagnostic imaging: A CT scan or MRI will be used to confirm the presence and location of the epidural hematoma.
Surgery: The main treatment for an epidural hematoma is surgical evacuation of the clot. This involves removing the blood clot through a procedure called a craniotomy, where a section of the skull is temporarily removed to access the hematoma.
Monitoring and supportive care: After surgery, the patient may be monitored in the intensive care unit (ICU) to watch for any complications and provide supportive care. This may include medication to control brain swelling and prevent seizures.
Rehabilitation: Depending on the extent of brain injury and recovery, rehabilitation may be needed to help the patient regain lost functions and abilities.

The outcome of treatment for an epidural hematoma depends on factors such as the size and location of the hematoma, the extent of brain injury, and how quickly treatment is administered. Prompt recognition and treatment of an epidural hematoma are essential for a good prognosis.

What is the mortality rate for epidural hematoma?

The mortality rate for epidural hematoma (EDH) varies depending on the severity of the bleed, the location of the bleed, and the promptness and effectiveness of treatment.

According to various studies, the mortality rate for EDH is estimated to be around 10-20%. However, this rate can range from as low as 5% to as high as 40% depending on the specific circumstances.

Here are some general guidelines on mortality rates for EDH based on the severity of the bleed:

Mild EDH (0-10 mL of blood): Mortality rate around 5-10%
Moderate EDH (11-50 mL of blood): Mortality rate around 15-25%
Severe EDH (51-100 mL of blood): Mortality rate around 25-40%

It’s worth noting that these rates are generally higher for older adults and individuals with underlying medical conditions.

In terms of specific studies, here are some examples:

A study published in the Journal of Neurosurgery found a mortality rate of 14.5% for EDH patients who underwent surgical evacuation.
A study published in the Journal of Neurotrauma found a mortality rate of 20.5% for EDH patients who did not undergo surgery.
A study published in the journal Neurology found a mortality rate of 12.1% for EDH patients who received medical treatment only.

Overall, while mortality rates for EDH vary depending on several factors, it’s clear that prompt and effective treatment can significantly improve outcomes and reduce mortality rates.