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| | __NOTOC__ |
| {{DiseaseDisorder infobox | | | {{DiseaseDisorder infobox | |
| Name = Extradural haemorrhage | | | Name = Extradural haemorrhage | |
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| DiseasesDB = 4353 | | | DiseasesDB = 4353 | |
| MedlinePlus = 001412 | | | MedlinePlus = 001412 | |
| eMedicineSubj = emerg |
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| eMedicineTopic = 167 |
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| eMedicine_mult = {{eMedicine2|med|2898}} {{eMedicine2|neuro|574}} |
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| MeshID = D006407 | | | MeshID = D006407 | |
| }} | | }} |
| {{SI}}
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| {{CMG}}
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| {{Editor Help}} | | {{Epidural hematoma}} |
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| '''Epidural''' or '''extradural hematoma''' is a buildup of blood occurring between the [[dura mater]] (the [[brain|brain's]] tough outer membrane) and the [[skull]]. Often due to [[head trauma|trauma]], the condition is potentially deadly because the buildup of blood may increase [[intracranial pressure|pressure]] in the [[intracranial space]] and compress delicate brain tissue. 15 to 20% of patients with epidural hematomas die of the [[injury]].<ref>Sanders MJ and McKenna K. 2001. ''Mosby’s Paramedic Textbook'', 2nd revised Ed. Chapter 22, "Head and Facial Trauma." Mosby.</ref>
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| == Diagnosis == | | == [[Epidural hematoma overview|Overview]] == |
| === Causes ===
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| The cause of epidural hematoma is usually [[brain trauma|traumatic]], although spontaneous hemorrhage is known to occur. Hemorrhages commonly result from acceleration-deceleration trauma and transverse forces.<ref name="uv">University of Vermont College of Medicine. [http://web.archive.org/web/20050309165318/http://cats.med.uvm.edu/cats_teachingmod/pathology/path302/np/home/neuroindex.html "Neuropathology: Trauma to the CNS."] Accessed through web archive. Retrieved on February 6, 2007.</ref><ref name="McCaffrey">McCaffrey P. 2001. [http://www.csuchico.edu/~pmccaff/syllabi/SPPA336/336unit11.html "The Neuroscience on the Web Series: CMSD 336 Neuropathologies of Language and Cognition."] California State University, Chico. Retrieved on February 6, 2007.</ref> [[vein|Venous]] epidural bleeds are usually due to shearing injury from rotational or linear forces, caused when tissues of different densities slide over one another.
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| 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]].<ref name="Shepherd">Shepherd S. 2004. [http://www.emedicine.com/med/topic2820.htm "Head Trauma."] Emedicine.com. Retrieved on February 6, 2007.</ref> Thus only 20 to 30% of epidural hematomas occur outside the region of the temporal bone.<ref>Graham DI and Gennareli TA. Chapter 5, "Pathology of Brain Damage After Head Injury" Cooper P and Golfinos G. 2000. Head Injury, 4th Ed. Morgan Hill, New York.</ref> | | == [[Epidural hematoma pathophysiology|Pathophysiology]] == |
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| === Physical Examination === | | == [[Epidural hematoma causes|Causes]] == |
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| ==== Appearance of the Patient ==== | | == [[Epidural hematoma differential diagnosis|Differentiating Epidural hematoma from other Diseases]] == |
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| ==Features== | | == [[Epidural hematoma epidemiology and demographics|Epidemiology and Demographics]] == |
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| Epidural bleeds, like [[subdural hematoma|subdural]] and [[subarachnoid hemorrhage]]s, are [[extra-axial hemorrhage|extra-axial bleeds]], occurring outside of the brain tissue, while [[intra-axial hemorrhage]]s, including [[intraparenchymal hemorrhage|intraparenchymal]] and [[intraventricular hemorrhage]]s, occur within it.<ref>Wagner AL. 2006. [http://www.emedicine.com/radio/topic664.htm "Subdural Hematoma."] Emedicine.com. Retrieved on February 6, 2007. </ref>
| | == [[Epidural hematoma risk factors|Risk Factors]] == |
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| Epidural bleeding is rapid because it is usually from arteries, which are high pressure. Epidural bleeds from arteries can grow until they reach their peak size at six to eight hours post injury, spilling from 25 to 75 cubic centimeters of blood into the [[intracranial space]].<ref name="uv"/> As the hematoma expands, it strips the dura from the inside of the skull, causing an intense headache. | | == [[Epidural hematoma natural history, complications and prognosis|Natural History, Complications and Prognosis]] == |
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| Epidural bleeds can become large and raise [[intracranial pressure]], causing the brain to shift, lose blood supply, or be crushed against the skull. Larger hematomas cause more damage. Epidural bleeds can quickly expand and compress the brain stem, causing [[coma|unconsciousness]], [[abnormal posturing]], and abnormal [[pupil]] responses to light.<ref name="singh Stock">Singh J and Stock A. 2006. [http://www.emedicine.com/ped/topic929.htm "Head Trauma."] Emedicine.com. Retrieved on [[February 6]], [[2007]].</ref>
| | == Diagnosis == |
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| 10% of epidural bleeds may be venous.<ref name="Shepherd"/>
| | [[Epidural hematoma history and symptoms|History and Symptoms]] | [[Epidural hematoma physical examination|Physical Examination]] | [[Epidural hematoma laboratory findings|Laboratory Findings]] | [[Epidural hematoma electroencephalogram|Electroencephalogram]] | [[Epidural hematoma CT|CT]] | [[Epidural hematoma MRI|MRI]] |
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| On images produced by [[CT scan]]s and [[MRI]]s, epidural hematomas usually appear convex in shape because their expansion stops at skull's [[skull suture|sutures]], where the dura mater is tightly attached to the skull. Thus they expand inward toward the brain rather than along the inside of the skull, as occurs in [[subdural hematoma]]. The lens like shape of the hematoma leads the appearance of these bleeds to be called "lentiform".
| | == Treatment == |
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| Epidural hematomas may occur in combination with subdural hematomas, or either may occur alone.<ref name="Shepherd"/> CT scans reveal subdural or epidural hematomas in 20% of unconscious patients.<ref name="Downie">Downie A. 2001. [http://www.radiology.co.uk/srs-x/tutors/cttrauma/tutor.htm "Tutorial: CT in Head Trauma"]. Retrieved on February 6, 2007.</ref> | | [[Epidural hematoma medical therapy|Medical therapy]] | [[Epidural hematoma surgery|Surgery]] | [[Epidural hematoma primary prevention|Primary Prevention]] | [[Epidural hematoma secondary prevention|Secondary Prevention]] | [[Epidural hematoma cost-effectiveness of therapy|Cost Effectiveness of Therapy]] | [[Epidural hematoma future or investigational therapies|Future or Investigational Therapies]] |
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| In the hallmark of epidural hematoma, patients may regain consciousness during what is called a [[lucid interval]], only to descend suddenly and rapidly into unconsciousness later. The lucid interval, which depends on the extent of the injury, is a key to diagnosing epidural hemorrhage. If the patient is not treated with prompt surgical intervention, death is likely to follow.<ref name="Caroline">Caroline NL. 1991. ''Emergency Medical Treatment''. Little Brown & Company.</ref>
| | == Case Studies == |
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| <gallery>
| | [[Epidural hematoma case study one|Case #1]] |
| Image:epidural hematoma.jpg|Epidural Hematoma <ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages</ref>
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| Image:Epidural_hematoma2.jpg|Epidural hematomas usually look convex on CT scans
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| Image:Skull interior anatomy.svg|The interior of the skull has sharp ridges by which a moving brain can be injured.
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| </gallery>
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| ==Treatment== | | == See also == |
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| As with other types of [[intracranial hematoma]]s, the blood may be aspirated surgically to remove the mass and reduce the pressure it puts on the brain.<ref name="McCaffrey"/> The hematoma is [[neurosurgery|neurosurgically]] evacuated through a [[burr hole]] or [[craniotomy]]. The diagnosis of epidural hematoma requires a patient to be cared for in a facility with a neurosurgeon on call to decompress the hematoma if necessary and stop the bleed by ligating the injured vessel branches.
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| ==Epidural hematoma in the spine==
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| Bleeding into the epidural space in the spine may also cause epidural hematoma. These may arise spontaneously (e.g. during [[childbirth]], or as a rare complication of anaesthesia (such as [[epidural]] anaesthesia) or surgery (such as laminectomy).
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| The anatomy of the epidural space means that spinal epidural hematoma has a different profile from cranial epidural hematoma. In the spine, the epidural space contains loose fatty tissue, and the '''epidural venous plexus''', a network of large, thin-walled veins. This means that bleeding is likely to be venous. Anatomical abnormalities and [[coagulopathy| bleeding disorder]]s make these lesions more likely.
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| They may cause pressure on the spinal cord or [[cauda equina]], which may present as pain, muscle weakness, or bladder and bowel dysfunction.
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| The diagnosis may be made on clinical appearance and time course of symptoms. It usually requires [[MRI]] scanning to confirm.
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| The treatment is surgical decompression.
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| The incidence of epidural hematoma following epidural anaesthesia is extremely difficult to quantify; estimates vary from 1 per 10,000 to 1 per 100,000 epidural anaesthetics. This means that a typical anaesthetist or [[anesthesiologist]] is statistically unlikely to cause one in a whole career.
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| ==Trivia==
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| The character of Pavel Chekov suffers from an epidural hematoma in the movie Star Trek IV. The physician states to Leonard McCoy that "an evacuation of the expanding epidural hematoma will relieve the pressure!" to which McCoy answers that drilling holes in the head is not the answer and that the correct solution is to repair the ruptured [[artery]].
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| ==See also==
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| * [[Intracranial hematoma]] | | * [[Intracranial hematoma]] |
| :* [[Extra-axial hematoma]] | | :* [[Extra-axial hematoma]] |
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| ::* [[Subarachnoid hemorrhage]] | | ::* [[Subarachnoid hemorrhage]] |
| :* [[Intra-axial hematoma]] | | :* [[Intra-axial hematoma]] |
| * [[Diffuse axonal injury]] | | * [[Diffuse axonal injury]] |
| * [[Concussion]] | | * [[Concussion]] |
| * [[Brain contusion]] | | * [[Brain contusion]] |
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| ==References==
| | {{Injuries, other than fractures, dislocations, sprains and strains}} |
| <references/>
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| ==External links==
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| * [http://rad.usuhs.mil/medpix/medpix.html?mode=single&recnum=810 MedPix: Epidural hematoma]
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| {{Cerebral hemorrhage}}
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| {{Injuries, other than fractures, dislocations, sprains and strains}}
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| {{SIB}}
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| [[Category:Neurotrauma]] | | [[Category:Neurotrauma]] |
| [[Category:Neurology]] | | [[Category:Neurology]] |
| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
| | [[Category:Overview complete]] |
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| [[de:Hirnblutung]] | | [[de:Hirnblutung]] |
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