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 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.

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

The health care provider should be consulted for any 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).

The typical symptom pattern of loss of consciousness, followed by alertness, then loss of consciousness again may not appear in all people, but strongly indicates an extradural hemorrhage.

The most important symptoms of an extradural hemorrhage are:

• Headache, severe
• Drowsiness
• Confusion
• Nausea or vomiting may accompany the headache
• Dizziness
• Enlarged pupil in one eye
• Weakness of part of the body, usually on the opposite side from the side with the enlarged pupil
• Head injury or trauma followed by loss of consciousness, an alert period of time, then rapid deterioration back to unconsciousness

The symptoms usually occur within minutes to hours after a head injury and indicate an emergency situation.

Signs and tests

The neurologic examination may indicate that a specific part of the brain is malfunctioning (for instance, arm weakness on one side) or may indicate increased intracranial pressure.

If there is increased intracranial pressure, emergency surgery may be needed in order to relieve the pressure within the head and spare the brain from further injury.

A head CT scan will confirm the diagnosis of an extradural hemorrhage and will pinpoint the exact location of the hematoma and any associated skull fracture.

Treatment

An extradural hemorrhage is an emergency condition! Treatment goals include taking measures to save the person's life, controlling symptoms, and minimizing or preventing permanent damage to the brain.

Life support measures may be required. Emergency surgery is almost always necessary to reduce pressure within the brain. This may include drilling a small hole in the skull to relieve pressure and allow drainage of the blood from the brain.

Large hematomas or solid blood clots may need to be removed through a larger opening in the skull (craniotomy).

Medications used in addition to surgery will vary according to the type and severity of symptoms and brain damage that occurs.

Anticonvulsant medications (such as phenytoin) may be used to control or prevent seizures. Some medications called "hyperosmotic agents" (like mannitol, glycerol, and hypertonic saline) may be used to reduce brain swelling.

Expectations (prognosis)

An extradural hemorrhage has a high risk of death without prompt surgical intervention. Even with prompt medical attention, a significant risk of death remains.