Extradural hemorrhage Health Article

Definition

An extradural hemorrhage is bleeding between the inside of the skull and the outer covering of the brain (called the "dura").

Alternative Names

Extradural hematoma; Epidural hematoma

Causes, incidence, and risk factors

An extradural hemorrhage is often caused by a skull fracture during childhood or adolescence. This type of bleeding is more common in young people because the membrane covering the brain is not as firmly attached to the skull as it is in older people.

An extradural hemorrhage occurs when there is a rupture of a blood vessel, usually an artery, which then bleeds into the space between the "dura mater" and the skull. The affected vessels are often torn by skull fractures.

This is most often the result of a severe head injury, such as those caused by motorcycle or automobile accidents. Extradural hemorrhages can be caused by venous (from a vein) 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). This pressure may result in additional brain injury.

An extradural hemorrhage is an emergency because it may lead to permanent brain damage and death if left untreated. There may be a rapid worsening within minutes to hours, from drowsiness to coma and death.

Symptoms

A health care provider should be consulted for any head injury that results in even a brief loss of consciousness or if there are any other symptoms after a head injury (even without loss of consciousness).

The typical pattern of symptoms that indicate an extradural hemorrhage is loss of consciousness, followed by alertness, then loss of consciousness again. But this pattern may NOT appear in all people.

The most important symptoms of an extradural hemorrhage are:

• Confusion
• Dizziness
• Drowsiness or altered level of alertness
• Enlarged pupil in one eye
• Headache (severe)
• Head injury or trauma followed by loss of consciousness, an period of alertness, then rapid deterioration back to unconsciousness
• Nausea and/or vomiting
• 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.