Epidural Hematoma

In an epidural hematoma, blood accumulates between the skull and the brain's outermost protective layer. The condition is relatively rare and affects a small percentage of all head injuries. Its life-threatening nature means patients just need immediate medical attention.

Males, particularly young adults, face a higher risk than females. Road traffic collisions cause nearly half of all cases. A patient's symptoms often include severe headache, confusion, dizziness, drowsiness, and sometimes an enlarged pupil in one eye. Without quick surgical intervention the risk of severe neurological complications increases. Doctors use CT scans to identify epidural hematoma's characteristic lens-shaped blood collection and plan the right treatment approach.

What is an Epidural Hematoma (EDH)?

Head trauma can lead to bleeding between the skull and dura mater, which creates an epidural haematoma. Doctors also call this condition an extradural haemorrhage. The blood builds up in this space and puts pressure on the brain. Quick treatment becomes crucial to prevent severe brain damage.

Symptoms of Epidural Hematoma 

The typical pattern looks like this:

• The person loses consciousness right after the injury
• A "lucid interval" follows where they seem normal
• Their neurological condition gets worse quickly

This pattern shows up in many cases. Other epidural hematoma symptoms are:

• Intense headaches
• Mental confusion and sleepiness
• Feeling sick and throwing up
• One eye's pupil becomes larger
• One side of the body feels weak
• Seizures start happening

Causes of Epidural Hematoma

EDH usually happens because of:

• Skull fractures (mostly in the temporal bone)
• Middle meningeal artery tears
• Blood vessel ruptures

Head injuries cause most cases, but EDH can happen spontaneously from infections, blood clotting problems, or unusual blood vessel formations.

Risk factors

Your chances of getting EDH go up if you:

• Are male (four times more likely than females)
• Are a young adult (rarely happens after 60)
• Have had head injuries before
• Take blood-thinning medications
• Drink too much alcohol

Complications of Epidural Hematoma

Without treatment EDH can lead to serious problems like:

• Brain herniation that might be fatal
• Lasting brain damage
• Seizures that could continue even after treatment
• Paralysis that doesn't go away
• Coma 

Diagnosis

• Imaging: Doctors diagnose epidural hematoma through advanced brain imaging techniques. Quick diagnosis and treatment directly affect patient outcomes in critical situations. These include:
  • CT scans are the main diagnostic tool for epidural haematoma and show a lens-shaped mass that pushes against brain tissue. The epidural haemorrhages' convex shape comes from their inability to cross skull suture lines. 
  • MRI provides better sensitivity to detect smaller bleeds that CT scans might miss. 
• Blood analysis: A patient's blood tests are a vital part of assessing clotting function and help determine bleeding risk.

Treatments

Treatment options are:

• Monitoring: Small bleeds (less than 30mL in volume and 15mm in thickness) that cause minimal symptoms might need only close monitoring. 
• Surgery: Surgical intervention is the core of epidural hematoma treatment. Doctors suggest craniotomy with hematoma evacuation—removing part of the skull to clear the blood clot—the most effective neurosurgical procedure.
• Medications: 
  • After surgery, patients may need medicines like mannitol or hypertonic saline to reduce brain swelling
  • Doctors might recommend antiseizure drugs to prevent seizures. 
• Supportive care: Involves giving oxygen, IV fluids and watching brain function in an ICU.

Patients who experience brain damage often need rehabilitation therapies.

When to See a Doctor

Get emergency medical care right after any head injury if you notice:

• Loss of consciousness
• Severe headache
• Slurred speech
• Confusion
• Nausea or vomiting
• Pupil changes (especially one pupil larger than the other)
• Weakness in limbs

Conclusion

Epidural hematoma is a serious medical condition that just needs quick recognition and action. This condition is relatively rare among head injuries but carries potential risks if left untreated. 

Time is a vital factor in survival. Patients who get treatment within two hours of worsening symptoms have substantially better outcomes compared to those who face delays. Anyone who experiences severe headache, confusion, or changes in their pupils after head trauma should seek emergency care right away.

Modern medical imaging helps doctors quickly spot the characteristic lens-shaped blood collection. Small bleeds might get better with careful monitoring. Larger ones need surgical intervention through craniotomy - currently the most budget-friendly neurosurgical procedure available.

Many patients need rehabilitation to deal with lingering effects after immediate treatment. The trip might look daunting, but quick medical care substantially improves recovery chances. People who suspect head trauma should play it safe and get a medical evaluation quickly - this simple decision could save their life.

FAQs

1. What happens if an epidural hematoma is left untreated?

Leaving an epidural hematoma untreated can lead to quick worsening. When blood builds up, it puts pressure on the skull squeezing the brain and disrupting crucial functions. A person might go through what's called a "lucid interval," where they seem okay at first but then collapse, fall into a coma, and face deadly brain herniation.

2. What is the recovery time for an epidural hematoma?

The time to recover depends on how serious the condition is and how doctors treat it. If surgery happens many people get back to basic activities in 2 to 6 weeks. However, regaining their neurological abilities can take several months. Acting fast on treatment improves chances, with some managing to return to normal life within just weeks.

3. When should you worry about a hematoma?

You need to get to a doctor right away if you have a bad headache, feel confused, throw up, have a seizure, or pass out after hurting your head. Any hematoma that happens from a head injury must be checked in the emergency room especially if you feel sleepy, have trouble talking, or feel weak on one side.

4. Do you need surgery to remove a hematoma?

Doctors recommend surgery to remove an epidural hematoma, and they use a procedure called a craniotomy. Emergency surgery is often the answer if the hematoma is pushing a lot on the brain or is over 30ml in size. Sometimes smaller ones can be watched, but in most situations, surgery is the go-to solution to treat them.

5. What is the difference between an epidural and subdural bleeding?

Epidural bleeding happens in the space between the skull and the dura, which is the outer layer protecting the brain. It results from torn arteries and often shows a "lucid interval" before symptoms worsen. Subdural bleeding forms beneath the dura and is caused by torn veins. This kind of bleeding develops more, with symptoms taking days or sometimes weeks to show instead of just hours.

Dr. Ashish Bagdi

MBBS, MD (Medicine), DM (Neurology)
CARE CHL Hospitals, Indore

To Book an Appointment, call:

+91 406 810 6585