Contents

Search

epidural hematoma

Pathology: - commonly occurs with a temporal skull fracture tearing the middle meningeal artery - expansion of the initial hematoma may lead to a mass effect &, in a worse-case senario, cerebral herniation & death - the brain is generally not significantly injured - spinal epidural hematoma may occur secondary to surgery - anticoagulation increases risk Clinical manifestations: - severe headache - vomiting - loss of consciousness [6] - the patient may have a lucid interval after loss of consciousness until the hematoma expands resulting in rapid deterioration [6] Radiology: - computed tomography - dome-shaped hyperintensity (acute) - magnetic resonance imaging (MRI) - contrast enhancement on T1-weighted images - may be hyperintense on T2-weighted scan [6] Complications: - cerebral herniation through tentorium cerebelli - stupor or coma, cranial nerve 3 palsy & contralateral hemiparesis may herald [6] Differential diagnosis: - subdural hematoma - clinical deterioration is generally slower over days to weeks, but it is often difficult to clinically distinguish Management: - if patient is anticoagulated - stop anticoagulant - reverse anticoagulation [6] - neurosurgical consultation - without immediate surgical evacuation, patients can die within a matter of hours [6] - with immediate sugical evacuation, prognosis is generally good [6]

Related

middle meningeal artery subdural hematoma

General

intracranial hematoma

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1076-79
  2. PubMed Health: Extradural hemorrhage http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002385/
  3. Medline Plus: Extradural hemorrhage http://www.nlm.nih.gov/medlineplus/ency/article/001412.htm
  4. Wikipedia: Epidural hematoma http://en.wikipedia.org/wiki/Epidural_hematoma
  5. Price AD and Kulkarn R Medscape (eMedicine) Epidural Hematoma in Emergency Medicine http://emedicine.medscape.com/article/824029-overview
  6. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2021. - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  7. Glotzbecker MP, Bono CM, Wood KB, Harris MB. Postoperative spinal epidural hematoma: a systematic review. Spine (Phila Pa 1976). 2010 May 1;35(10):E413-20 PMID: 20431474

Images

image related to epidural hematoma