Epidural hematoma - Causes, Symptoms, Diagnosis and Treatment

Epidural hematoma - Accumulation of blood that fills formed as a result of the injury the space between the bones of the skull and cerebral hard shell. In typical cases, characterized by a disturbance of consciousness with the presence of the light period, signs of intracranial hypertension and brain compression, focal symptoms, relevant hematomas location. The diagnosis is made on the basis of the clinic using craniography, Echo-EG, cerebral angiography, CT and MRI. The treatment mainly surgical - craniotomy, removing a hematoma, search and elimination of the source of bleeding.

  • Causes of epidural hematoma
  • The symptoms of an epidural hematoma
  • Diagnosis of epidural hematoma
  • Treatment and prognosis of epidural hematoma
  • Epidural hematoma - treated

  • Epidural hematoma


    epidural hematoma localization observed rarely. On average, epidural hematoma is approximately 1-1.5% of all head injuries, but in severe TBI is found in 9% of the victims. In such cases epidural hematoma may be associated with brain contusion and subdural hematoma. The most common epidural hematoma occurs among young people 16-25 years. In this age group 75% of cases are male. Among young children and elderly epidural hemorrhage in boys and men is noted in 2 times more often than girls and women. Patients with post-traumatic hematoma jointly supervised by experts in the field of traumatology and neurology.

    bleeding may be the middle meningeal artery and its branches, meningeal veins, venous sinuses and veins diploic - located in the skull bones thicker venous channels.

    vascular damage often caused by depressed skull fracture. Until now, no single views on the mechanism of formation of a hematoma under epidural bleeding. Some authors say that in the beginning there is a detachment of solid cerebral shell, and then collects the blood in the cavity as a result of injury. Other experts in the field of neurology and traumatology believe that the shell of detachment occurs as the outpouring of blood and accumulation. Typically, epidural hematoma does not exceed 8 cm in diameter, and its volume is 80 to 120 ml, although it may vary in the range 30-250 ml. A distinctive feature of epidural hematoma localization is to reduce its thickness from the center to the periphery. Due to the limited volume of the cavity of the skull accumulation of blood over the hard shell leads to intracranial hypertension and compression of the brain tissue to be.

    dizziness, weakness, mild headache. There is a retro and kongradnaya amnesia, unexpressed anizorefleksiya, some asymmetry of nasolabial folds, light meningeal signs, spontaneous nystagmus. State originally considered as mild or moderate TBI. The duration of the interval of light varies from 30-40 minutes to several hours.

    After a light period condition of the victim rapidly deteriorating. There is growing headache, appear nausea and vomiting, agitation is replaced by rapidly progressive disorder of consciousness, from stupor to sopor and coma. Sometimes there is a rapid extinction of consciousness to transition immediately into a coma. There bradycardia, arterial hypertension; in neurological status - increasing the brachiocephalic paresis (paresis of the facial nerve and muscle weakness in the upper extremity) hematoma on the opposite side. On the side there is a hematoma mydriasis, and then the lack of response to light. In some cases of epidural hematoma at the forefront focal symptoms (paresis, anisocoria), the advanced development of the symptoms of brain compression.

    Often epidural hematoma occurs with blurred light period. Typically, in such cases, the original there is a deep disturbance of consciousness (coma), and is regarded as a severe head injury. A few hours later replaced coma stupor, becomes possible some verbal contact with the patient. The behavior of the victim becomes clear that he has an intense headache. Normally there is a slight or mild hemiparesis. This is not a distinct light period may last from minutes to days. Following this, the condition worsens: growing excitement which then goes into a coma, paresis compounded up to the full plegia hematoma contralateral limb. Can gormetoniya (tonic paretic limb muscle contraction), severe vestibular and oculomotor disorders, other manifestations of lesions of the brain stem. There are violations of the vital functions.

    Relatively rare epidural hematoma without a light period. There are usually in severe head injury with multiple brain damage. Coma develops immediately after injury and remains unchanged. Subacute epidural hematoma differ long duration of the light period (10-12 days). During this period, the victim consciousness mostly clear, there is a tendency to bradycardia, individual light focal symptoms. Subsequently, there is a gradual, sometimes wavy, aggravation of violations of consciousness to deep stun, which is preceded by severe headache and excitement. In the fundus during ophthalmoscopy can be detected stagnation of the optic nerve, showing cerebral compression.

    Focal symptoms that accompany epidural hematoma depends on its location. When hemorrhage in the parasagittal area is dominated by pyramidal disorders with the greatest severity of paresis in the foot. Epidural hematoma of the frontal lobe is accompanied by mental disorders with the frontal color with low expression of other focal symptoms. Epidural hematoma of the occipital region of the same name appears loss of visual fields - homonymous hemianopsia.

    neurologist or neurosurgeon with the participation of trauma according to the history and typical clinical manifestations: delirium, unilateral mydriasis and contralateral hemiparesis him, bradycardia, etc. According to a skull x-ray reveals the presence of a fracture, which crosses the groove meningeal vessels. In 90% of cases of epidural hematoma is localized, respectively, at the fracture site. Echoencephalography usually diagnose progressive displacement of the medial echo. Echo-EG retained its importance in the diagnosis of intracranial hematomas in the absence of such modern techniques like MRI or CT.

    Epidural hematoma can be confirmed by cerebral angiography during which detects avascular region in the form of a convex lens. More precise data on the volume and location of hematoma location, as well as other intracranial lesions, can give the brain CT. Izodensivnaya and small-sized hematoma epidural visualized using brain MRI. MRI is also used for the differentiation of epi- and subdural hematomas, for the assessment of basal structures and the brainstem.

    removal of an epidural hematoma, search and ligation of the damaged vessel. When bleeding from the veins of coagulated and tamponiruyut hemostatic sponge. If damaged sinuses produce their plastic and tamponade. When bleeding from veins diploic surgical wax used.

    The operation is performed on the background of anti, hemostatic, and symptomatic therapy. The recovery period is used and neyrometabolicheskie absorbable preparations for the speedy recovery of strength in the muscles of the paretic limbs conduct massage and physiotherapy exercises.

    About a quarter of epidural hemorrhage end with a lethal outcome. Prognosis depends on the amount of bruising, victim age, timing of surgical treatment. During the operation at the stage of mild decompensation lowest mortality, mainly it marked a good recovery of lost neurological functions. A favorable outcome also is conducted according to strict indications Conservative treatment of subacute hematomas small. Alarm forecast hematoma have operated on at the stage of decompensation. In such cases, the death rate up to 40%, often observed in surviving significant neurological deficit.