Epidural Hematoma

Epidural Hematoma a Dangerous Blood Clots on the Brain

2009-09-11T19:41:00.000-07:00

To understand Epidural Hematoma, two serious consequences of head injuries, we need to know the basic anatomy of the brain and its coverings. Imagine an evil carpenter with an electric drill intent on drilling into a person's brain. The drill would pass through the skin and then the skull (braincase) before penetrating a series of three membranes comprising the meninges. In sequence, the three membranes are the dura mater (Latin for "tough mother"), the arachnoid mater (cobwebby mother) and the pia mater (tender mother) and then finally the brain itself.

Epidural hematoma are alike in that they are masses of clotted blood (hematomas) caused by head trauma and deposited outside the brain but inside the skull. However, they differ in their locations relative to the dura mater. An epidural hematoma lies outside (on top of) the dura mater, while a subdural hematoma lies inside (beneath) the dura mater and outside the arachnoid mater. Thus, the locations of the two kinds of hematoma are encoded in their names -- "epi" is Greek for "upon" and "sub" is Latin for "below." A third kind of hematoma caused by head injuries is traumatic intracerebral hemorrhage. These occur within the brain tissue itself and are no less serious than those outside the brain, but are not the subject of the current essay.

Epidural hematoma are produced by ruptures of different blood vessels. Epidural hematoma are usually caused by bleeding from an artery that nourishes the meninges known as the middle meningeal artery, while subdural hematomas are usually due to bleeding from veins that drain blood away from the surface of the brain.

Yet another difference between epidural and subdural hematomas is what they look like on computed tomographic (CT) scans. When the bleeding was recent, both show up as intensely bright objects on the scan, but the shapes of the blood clots are different. In epidural hematoma the blood is more limited in its spread because it has to push harder to move outward in the tight space between the inner surface of the skull and the outer surface of the dura mater. In contrast, the bleeding that produces subdural hematomas is more free to spread in the looser space beneath the dura mater and typically runs from the front of the head to the rear.

One issue that applies to both kinds of hematomas is that they occupy space -- sometimes a lot of it -- within the braincase where there isn't a lot of extra space to go around. As they expand they compress the brain tissue next to them and additionally raise the pressure within the skull which can damage the rest of the brain. Moreover, the hematoma is not necessarily the only problem caused by the head injury. The blow to the head that caused the bleed can also damage the brain tissue directly.

Who gets epidural hematoma? They usually occur in people with obvious and significant blows to the head, as from motor vehicle accidents. In one study they were present in 10% of head-injured patients who arrived at an emergency department in coma, but they can also be seen in conscious patients. Epidural hematoma usually occur in conjunction with skull fractures, and this is no coincidence, as the ruptured blood vessel often lies beneath the fracture. The presence of an epidural hematoma signifies a highly dangerous condition. Between 5 and 43% of people who have them die. Emergency surgery to remove the clot is the usual treatment.

When considering subdural hematomas, it is useful to divide them into acute and chronic varieties, with "acute" meaning the hematoma is new, and "chronic" meaning it has been present for at least three weeks. (The hematoma can also pass through a "subacute" phase, meaning that it has been present for 3 days to 3 weeks.) By the time an acute subdural hematoma has become chronic, it is a thick liquid instead of a solid blood clot, and also appears darker on CT scans.

Acute subdural hematomas usually occur in people with obvious and significant blows to the head. In one study they were present in 24% of the patients who arrived at an emergency department in coma, but can be present in non-comatose patients as well. Acute subdural hematomas are associated with a death rate between 30 and 90%, with a figure of 60% typically cited. Emergency surgery is the usual treatment, though studies have shown that alert patients with small subdural hematomas can do as well without surgery if monitored closely for signs of worsening.

Infants are also vulnerable to acute subdural hematomas. Neurosurgeons at the Kaohsiung Medical University in Taiwan reviewed records on 21 children, ages 6 days to 12 months, who had acute subdural hematomas. In this case series, "shaken baby syndrome" was the most common cause. Eight of the infants underwent an immediate operation, and another 11 required delayed surgery. While most of the children did well, one baby died and another 7 sustained moderate to severe disabilities from their injuries.

Chronic subdural hematomas often show up in patients over 60 years of age in whom the head injuries that caused them might have seemed trivial when they occurred, or might even have been forgotten. Older people are especially vulnerable due to the fact that their brains have atrophied (shrunk) and the veins draining the surface of the brain are stretched and fragile, easily disrupted by glancing blows. Risk of subdural hematoma rises still higher if the individual falls a lot, drinks alcohol a lot or takes blood-thinning medication.

Subdural hematomas can expand progressively to the point of causing symptoms like headache, slurred speech, confusion, lethargy, unsteadiness or even a seizure. Surgery to remove the hematoma and stop the bleeding is the typical treatment, and 93 to 97% of patients survive to 30 days after surgery. Most regain their pre-injury level of function. Milder cases of chronic subdural hematoma can be monitored without surgery.

Epidural Hematoma Information

2009-08-14T07:29:00.000-07:00

Epidural hematoma (EDH) is a traumatic accumulation of blood between the inner table of the skull and the stripped-off dural membrane. Epidural hematoma commonly results from a blow to the side of the head and is frequently caused by a fracture that passes through an arterial channel in the bone, most commonly a break in temporal bone interrupting middle meningeal artery, a branch of the external carotid. The signs and symptoms of an Epidural hematoma include severe headache, dizziness, vomiting, increased size of one pupil or sudden weakness in an arm or leg.

Medicines used to treat a Epidural hematoma depend on the type of Epidural hematoma. Liquid blood can be drained from burr holes drilled into the skull. Emergency surgery may be needed to reduce pressure within the brain. Large hematomas or solid blood clots may need to be removed through a procedure called a craniotomy, which creates a larger opening in the skull. Corticosteroids and diuretics can control brain swelling. Rest in bed, stay warm, and limit your normal activities as much as possible for a few days. Always use safety equipment at work and play to reduce your risk of a head injury. Avoid head injuries by using seat belts, bicycle and motorcycle helmets, and hard hats when appropriate. You may also need to limit your diet to liquids.

Epidural Hematoma Treatment and Prevention Tips
1. Corticosteroids and diuretics can control brain swelling.
2. Surgery is generally recommended to remove the clot.
3. Liquid blood can be drained from burr holes drilled into the skull.
4. Always use safety equipment at work
5. You may also need to limit your diet to liquids.
6. Avoid head injuries by using seat belts, bicycle and motorcycle helmets.
7. Bag-valve-mask ventilation with good technique may be of more benefit to brain injured patients.

What is Epidural Hematoma?

2009-08-01T01:20:00.001-07:00

Epidural Hematoma is a pocket of blood that forms immediately outside the dura mater. The dura mater is the fibrous outermost sheath or membrane that encloses the brain and spinal cord. Epidural means outside the dura, and hematoma means mass of blood. Blood from the broken vessel forms a pressurized pocket of blood, like a large, internal blood blister.

The growing hematoma pushes against the rigid bone of the skull or spinal column and thus exerts pressure on the dura mater, which in turn pushes on the brain or spinal cord. This pressure may stretch and tear blood vessels or even force the brain to herniate through the foramen magnum, the hole in the bottom of the skull through which the spinal cord enters, or through the tentorium cerebelli, the part of the dura mater that covers the cerebellum and supports the occipital lobes from below. Herniation of the brain is likely to be fatal.

Epidural Hematoma are less common than subdural hematomas, which are the most common mechanism of fatal brain damage in head trauma. They are also distinguished from intracnial hematomas, volumes of blood that collect inside the brain rather than at its surface.

Traumatic brain injuries such as those that can result in cranial Epidural Hematoma are common. About 500,000 patients are admitted to hospitals in the United States annually with head injuries that cause brain damage, and some 75,000–90,000 of these patients die. Motor vehicle accidents are the most common cause of closed-head injuries, accounting for 50–70% of such injuries. Falls are the second most common cause of closed head trauma. Alcohol is a contributing factor in about 40% of severe head injuries. Sports such as football can result in traumatic head injury, but do so relatively rarely. Three-quarters of patients with brain injury are male, and the risk of traumatic brain injury declines steadily with age.

Subdural and Epidural Hematoma Info!

2009-07-25T08:23:00.000-07:00

Epidural Hematoma commonly results from a blow to the side of the head and is frequently caused by a fracture that passes through an arterial channel in the bone, most commonly a break in temporal bone interrupting middle meningeal artery, a branch of the external carotid. Epidural Hematoma may occur in combination with subdural hematomas, or either may occur alone. The signs and symptoms of an Epidural Hematoma include severe headache, dizziness, vomiting, increased size of one pupil or sudden weakness in an arm or leg. Medicines used to treat a subdural hematoma depend on the type of subdural hematoma. Liquid blood can be drained from burr holes drilled into the skull. Emergency surgery may be needed to reduce pressure within the brain. Large hematomas or solid blood clots may need to be removed through a procedure called a craniotomy, which creates a larger opening in the skull. Corticosteroids and diuretics can control brain swelling. Rest in bed, stay warm, and limit your normal activities as much as possible for a few days. Always use safety equipment at work and play to reduce your risk of a head injury. Avoid head injuries by using seat belts, bicycle and motorcycle helmets, and hard hats when appropriate. You may also need to limit your diet to liquids. Subdural and Epidural Hematoma Treatment and Prevention Tips 1. Corticosteroids and diuretics can control brain swelling. 2. Surgery is generally recommended to remove the clot. 3. Liquid blood can be drained from burr holes drilled into the skull. 4. Always use safety equipment at work 5. You may also need to limit your diet to liquids. 6. Avoid head injuries by using seat belts, bicycle and motorcycle helmets. 7. Bag-valve-mask ventilation with good technique may be of more benefit to brain injured patients.

Epidural Hematoma

2009-06-07T19:02:00.001-07:00

Epidural or extradural hematoma 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 and compress delicate brain tissue. The condition is present in one to three percent of head injuries. Between 15 and 20% of patients with epidural hematomas die of the injury.

The cause of epidural hematoma is usually traumatic, although spontaneous hemorrhage is known to occur. Hemorrhages commonly result from acceleration-deceleration trauma and transverse forces. 10% of epidural bleeds may be venous. Venous epidural bleeds are usually due to shearing injury from rotational or linear forces, caused when tissues of different densities slide over one another.

Epidural hematoma commonly results from a blow to the side of the head. The pterion region which overlies the middle meningeal artery is exceptionally 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. EDH 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 a contrecoup injury.

Epidural Hematoma

2009-05-26T18:43:00.000-07:00

Epidural Hematoma usually results from a brief linear contact force to the calvaria that causes separation of the periosteal dura from bone and disruption of interposed vessels due to shearing stress. Epidural hematoma When there is a direct blow to the head, the bruising of the brain and the damage to the internal tissue and blood vessels is due to a mechanism called coup-countercoup. An Epidural Hematoma occurs when a blood clot forms underneath the skull, but on top of the dura, the tough covering that surrounds the brain.
Skull fractures occur in 85-95% of adult cases. Arterial or venous structures may be compromised, causing rapid expansion of the hematoma; Extension of the hematoma usually is limited by suture lines owing to the tight attachment of the dura at these locations. Recent analyses have revealed that epidural hematoma may actually traverse suture lines in a minority of cases.
The temporoparietal region and the middle meningeal artery are involved most commonly (66%), although the anterior ethmoidal artery may be involved in frontal injuries, the transverse or sigmoid sinus in occipital injuries, and the superior sagittal sinus in trauma to the vertex. Bilateral epidural hematomas account for 2-10% of all acute epidural hematomas in adults but are exceedingly rare in children. Posterior fossa epidural hematomas represent 5% of all cases of epidural hematoma.
Patients with this type of condition frequently have bruises around their eyes and a bruise behind their ear. They may also have clear fluid draining from their nose or ears due to a tear in part of the covering of the brain. These patients usually require close observation in the hospital.
Spinal epidural hematoma may be spontaneous or may follow minor trauma, such as lumbar puncture or epidural anesthesia. Spontaneous spinal epidural hematoma may be associated with anticoagulation, thrombolysis, blood dyscrasias, coagulopathies, thrombocytopenia, neoplasms, or vascular malformations. The peridural venous plexus usually is involved, though arterial sources of hemorrhage also occur. The dorsal aspect of the thoracic or lumbar region is involved most commonly, with expansion limited to a few vertebral levels.
The full extent of the problem may not be completely understood immediately after the injury, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a head injury is made with a physical examination and diagnostic tests. During the examination, the physician obtains a complete medical history of the patient and family and asks how the injury occurred. Trauma to the head can cause neurological problems and may require further medical follow up.

Epidural Hematoma

2009-03-22T02:34:00.000-07:00

What is?

Epidural Hematoma Is the 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. An Epidural Hematoma is caused by bleeding between the inner skull wall and the outer membrane covering the brain, called the “dura mater” or “dura.”

Causes

The cause of Epidural Hematoma is usually traumatic. This is most often the result of a severe Head injury, such as those caused by motorcycle or automobile accidents. Epidural Hematoma can be caused by venous 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), which may result in additional brain injury.

Symptoms

Head injury that results in even a brief loss of consciousness or if other symptoms are present after Head injury (even without loss of consciousness), followed by alertness, then loss of consciousness again may not appear in all people, but strongly indicates an Epidural Hematoma. Weakness of part of the body, usually on the opposite side from the side with the enlarged pupil. the symptoms usually occur within minutes to hours after a Head injury and indicate an emergency situation.

Treatment

Epidural Hematoma in adults do not require treatment because the blood is absorbed on its own. If a Epidural Hematoma is large and is causing symptoms such as persisting headache, fluctuating drowsiness, confusion, memory changes, and paralysis on the opposite side of the body, doctors usually drain it surgically by drilling a small hole in the skull. During surgery, a drain is usually inserted and left in place for several days, because Epidural Hematoma can recur. The person is monitored closely for recurrences. In infants, doctors usually drain the hematoma for cosmetic if for no other reasons.