An epidural hematoma is an accumulation of blood between the dura mater’s outer layer and the inner table of the skull. The lateral sutures, particularly the coronal sutures where the dura integrates, maintains it.
It is a potentially fatal disorder that may need rapid treatment and can result in considerable mortality and morbidity if neglected. Quick diagnosis and emergency procedures are essential for a positive outcome.
Epidemiology
Epidural hematomas occur in 2% of most head injuries and about 15% of fatal head injuries. Males are more frequently impacted than females. Furthermore, young adults and adolescents are more likely to be affected. The average age of impacted patients is between 20 and 30 years, which is uncommon after 50-60 years.
The dura mater grows increasingly adhesive to the overlaying bone as an individual matures. This reduces the possibility of a hematoma forming between the skull and the dura.
Anatomy
Pathophysiology
Venous Injury
About 10% of epidural hematomas are caused by venous hemorrhage from a dural venous sinus laceration. Approximately 75% of epidural hematomas in adults occur in the temporal area. In adolescents, however, they occur with comparable frequency in the posterior fossa and frontal, temporal, and occipital regions.
Most individuals with epidural hematoma have a skull fracture. These hematomas frequently appear behind a fracture of the temporal bone’s squamous part. When this condition arises in the spine, it is referred to as a spinal epidural hematoma.
It can be divided into one of the following categories based on radiographic progression:
Type I- Acute; develops on day one and is characterized by a whirl of unclotted blood.
Type II-Subacute, lasting two to four days, and generally solid.
Type III-Chronic, lasting 7 to 20 days; mixed or lucid look with contrast increase.
Arterial Injury
Most epidural hematomas are caused by arterial bleeding via a segment of the central meningeal artery. The vertex’s anterior meningeal artery or dural arteriovenous fistula may be impacted.
Etiology
It develops in around 10% of severe brain injuries that require hospitalization. Traumatic and non-traumatic processes can cause an epidural hematoma.
Most instances involving a traumatic mechanism result from a brain injury caused by an automobile accident, a physical attack, or an unintentional fall.
The following are examples of non-traumatic mechanisms:
Abscess/Infection
Coagulopathy
Bleeding tumors
Malformations of the Vasculature
Genetics
Prognostic Factors
The factors impacting the disease outcome are the patient’s age, the period between the injury and treatment, immediate coma, anomalies in pupillary dilation on arrival, and GCS or motor score.
Patients with true Epidural hematoma have a favorable prognosis of functional success following surgical drainage when it is diagnosed and removed promptly. Diagnosis and treatment delays increase morbidity and death.
Epidural hematomas produced by arterial hemorrhage proliferate and are easily noticed. On the other hand, those caused by a dural sinus tear grow more slowly. As a result, clinical signs would be delayed, resulting in a delay in detection and evacuation.
In general, an epidural hematoma volume of more than 50 cm preliminary to removal leads to a poorer neurological prognosis and, as a result, death.
Clinical History
Physical Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
Medication
Future Trends
Media Gallary
References
News
Vaping’s ‘95% Safer’ Claim Debated for Youth Health
Posted on
News
Google DeepMind’s AI Revolutionizes the Search for Disease Genes
Posted on
News
Mosquitoes Pose New Challenge to Public Health
Posted on
News
3D-Printed e3-skin Redefines Wearable Health Monitoring
An epidural hematoma is an accumulation of blood between the dura mater’s outer layer and the inner table of the skull. The lateral sutures, particularly the coronal sutures where the dura integrates, maintains it.
It is a potentially fatal disorder that may need rapid treatment and can result in considerable mortality and morbidity if neglected. Quick diagnosis and emergency procedures are essential for a positive outcome.
Epidural hematomas occur in 2% of most head injuries and about 15% of fatal head injuries. Males are more frequently impacted than females. Furthermore, young adults and adolescents are more likely to be affected. The average age of impacted patients is between 20 and 30 years, which is uncommon after 50-60 years.
The dura mater grows increasingly adhesive to the overlaying bone as an individual matures. This reduces the possibility of a hematoma forming between the skull and the dura.
Venous Injury
About 10% of epidural hematomas are caused by venous hemorrhage from a dural venous sinus laceration. Approximately 75% of epidural hematomas in adults occur in the temporal area. In adolescents, however, they occur with comparable frequency in the posterior fossa and frontal, temporal, and occipital regions.
Most individuals with epidural hematoma have a skull fracture. These hematomas frequently appear behind a fracture of the temporal bone’s squamous part. When this condition arises in the spine, it is referred to as a spinal epidural hematoma.
It can be divided into one of the following categories based on radiographic progression:
Type I- Acute; develops on day one and is characterized by a whirl of unclotted blood.
Type II-Subacute, lasting two to four days, and generally solid.
Type III-Chronic, lasting 7 to 20 days; mixed or lucid look with contrast increase.
Arterial Injury
Most epidural hematomas are caused by arterial bleeding via a segment of the central meningeal artery. The vertex’s anterior meningeal artery or dural arteriovenous fistula may be impacted.
It develops in around 10% of severe brain injuries that require hospitalization. Traumatic and non-traumatic processes can cause an epidural hematoma.
Most instances involving a traumatic mechanism result from a brain injury caused by an automobile accident, a physical attack, or an unintentional fall.
The following are examples of non-traumatic mechanisms:
Abscess/Infection
Coagulopathy
Bleeding tumors
Malformations of the Vasculature
The factors impacting the disease outcome are the patient’s age, the period between the injury and treatment, immediate coma, anomalies in pupillary dilation on arrival, and GCS or motor score.
Patients with true Epidural hematoma have a favorable prognosis of functional success following surgical drainage when it is diagnosed and removed promptly. Diagnosis and treatment delays increase morbidity and death.
Epidural hematomas produced by arterial hemorrhage proliferate and are easily noticed. On the other hand, those caused by a dural sinus tear grow more slowly. As a result, clinical signs would be delayed, resulting in a delay in detection and evacuation.
In general, an epidural hematoma volume of more than 50 cm preliminary to removal leads to a poorer neurological prognosis and, as a result, death.
medtigo
Epidural Hematoma
Updated :
October 13, 2022
An epidural hematoma is an accumulation of blood between the dura mater’s outer layer and the inner table of the skull. The lateral sutures, particularly the coronal sutures where the dura integrates, maintains it.
It is a potentially fatal disorder that may need rapid treatment and can result in considerable mortality and morbidity if neglected. Quick diagnosis and emergency procedures are essential for a positive outcome.
Epidural hematomas occur in 2% of most head injuries and about 15% of fatal head injuries. Males are more frequently impacted than females. Furthermore, young adults and adolescents are more likely to be affected. The average age of impacted patients is between 20 and 30 years, which is uncommon after 50-60 years.
The dura mater grows increasingly adhesive to the overlaying bone as an individual matures. This reduces the possibility of a hematoma forming between the skull and the dura.
Venous Injury
About 10% of epidural hematomas are caused by venous hemorrhage from a dural venous sinus laceration. Approximately 75% of epidural hematomas in adults occur in the temporal area. In adolescents, however, they occur with comparable frequency in the posterior fossa and frontal, temporal, and occipital regions.
Most individuals with epidural hematoma have a skull fracture. These hematomas frequently appear behind a fracture of the temporal bone’s squamous part. When this condition arises in the spine, it is referred to as a spinal epidural hematoma.
It can be divided into one of the following categories based on radiographic progression:
Type I- Acute; develops on day one and is characterized by a whirl of unclotted blood.
Type II-Subacute, lasting two to four days, and generally solid.
Type III-Chronic, lasting 7 to 20 days; mixed or lucid look with contrast increase.
Arterial Injury
Most epidural hematomas are caused by arterial bleeding via a segment of the central meningeal artery. The vertex’s anterior meningeal artery or dural arteriovenous fistula may be impacted.
It develops in around 10% of severe brain injuries that require hospitalization. Traumatic and non-traumatic processes can cause an epidural hematoma.
Most instances involving a traumatic mechanism result from a brain injury caused by an automobile accident, a physical attack, or an unintentional fall.
The following are examples of non-traumatic mechanisms:
Abscess/Infection
Coagulopathy
Bleeding tumors
Malformations of the Vasculature
The factors impacting the disease outcome are the patient’s age, the period between the injury and treatment, immediate coma, anomalies in pupillary dilation on arrival, and GCS or motor score.
Patients with true Epidural hematoma have a favorable prognosis of functional success following surgical drainage when it is diagnosed and removed promptly. Diagnosis and treatment delays increase morbidity and death.
Epidural hematomas produced by arterial hemorrhage proliferate and are easily noticed. On the other hand, those caused by a dural sinus tear grow more slowly. As a result, clinical signs would be delayed, resulting in a delay in detection and evacuation.
In general, an epidural hematoma volume of more than 50 cm preliminary to removal leads to a poorer neurological prognosis and, as a result, death.
Free CME credits
Both our subscription plans include Free CME/CPD AMA PRA Category 1 credits.
Digital Certificate PDF
On course completion, you will receive a full-sized presentation quality digital certificate.
medtigo Simulation
A dynamic medical simulation platform designed to train healthcare professionals and students to effectively run code situations through an immersive hands-on experience in a live, interactive 3D environment.
medtigo Points
medtigo points is our unique point redemption system created to award users for interacting on our site. These points can be redeemed for special discounts on the medtigo marketplace as well as towards the membership cost itself.
Community Forum post/reply = 5 points
*Redemption of points can occur only through the medtigo marketplace, courses, or simulation system. Money will not be credited to your bank account. 10 points = $1.
All Your Certificates in One Place
When you have your licenses, certificates and CMEs in one place, it's easier to track your career growth. You can easily share these with hospitals as well, using your medtigo app.
