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Epidural Hematoma

What is an epidural hematoma?

Highlights

  1. An epidural hematoma is when a mass of blood forms between your skull and brain.
  2. It can happen when you injure your head during a fall, collision, or other accident.
  3. You will likely need surgery and medication to treat it.

An epidural hematoma occurs when a mass of blood forms in the space between your skull and the protective covering of your brain. Trauma or other injury to your head can cause your brain to bounce against the inside of your skull. This can tear your brain’s internal lining, tissues, and blood vessels, which results in bleeding. This can cause a hematoma to form.

An epidural hematoma can put pressure on your brain and cause it to swell. As it swells, your brain may shift in your skull. Pressure on and damage to your brain’s tissues can affect your vision, speech, mobility, and consciousness. If left untreated, an epidural hematoma can cause lasting brain damage and even death.

If you suspect you have an epidural hematoma, get medical attention right away.

What are the symptoms of an epidural hematoma?

The symptoms of an epidural hematoma depend on its severity. They can arise minutes or hours after you sustain a head injury. You might have an epidural hematoma if you experience:

  • confusion
  • dizziness
  • drowsiness or varying levels of alertness
  • severe headache
  • nausea
  • vomiting
  • seizures
  • enlarged pupil in one of your eyes
  • loss of vision on one side
  • weakness on one part of your body
  • shortness of breath or other changes in your breathing patterns

You might lose consciousness for a brief period of time. This might be followed by a period of alertness before you fall unconscious again. You can even slip into a coma. 

What causes an epidural hematoma?

An epidural hematoma usually results from trauma or other injury to your head. For example, your brain may be subjected to a damaging blow during a fall, vehicular accident, or collision in contact sports. Physical abuse can also cause head injury and lead to an epidural hematoma.

Who is at risk of an epidural hematoma?

You’re at higher risk of developing an epidural hematoma if you:

  • are an older adult
  • have trouble walking without falling
  • have experienced trauma to your head
  • take blood thinning medications
  • drink alcohol, which increase your risk of falls and other accidents
  • don’t wear a protective helmet during contact activities
  • don’t wear a seatbelt while traveling in vehicles

How is an epidural hematoma diagnosed?

If your doctor suspects you have an epidural hematoma, they can use a variety of tests to diagnose and locate it. For example, they may order:

  • neurological tests
  • computed tomography (CT) scans or magnetic resonance imaging (MRI) to examine your skull and the soft tissue in your brain
  • electroencephalogram (EEG) to assess your brain’s electrical activity

How is an epidural hematoma treated?

Your recommended treatment plan for an epidural hematoma will depend on the severity of your condition and symptoms. Having other injuries or health conditions can also affect your treatment.

Surgery

In most cases, your doctor will recommend surgery to remove an epidural hematoma. It usually involves a craniotomy. In this procedure, your surgeon will open up part of your skull so they can remove the hematoma and reduce the pressure on your brain.

In other cases, your doctor may recommend aspiration. In this procedure, they will cut a small hole in your skull and use suction to remove the hematoma. This may only be effective for a very small hematoma that’s not putting pressure on your brain.

Medications

Before craniotomy or aspiration, your doctor might prescribe medications to reduce inflammation and intracranial pressure. For example, they may recommend hyperosmotic agents. These drugs can help reduce swelling in your brain. They include mannitol, glycerol, and hypertonic saline.

After your hematoma has been removed, your doctor may prescribe antiseizure medications. This can help prevent seizures — a possible complication of head injuries. You might need to take these medications for months or even years.

Rehabilitative therapy

Your doctor may refer you to a physical therapist, occupational therapist, or other therapist. They can help you manage symptoms and disabilities caused by your injury, such as:

  • weakness
  • incontinence
  • difficulty walking
  • paralysis or loss of sensation

They may recommend exercises to improve your physical abilities, along with other coping strategies.

Home care

Your recovery process can take time. Most improvements will occur within the first six months after your injury and treatment. Additional improvements may take up to two years.

To help promote your recovery process, your doctor will likely encourage you to:

  • Follow their recommended treatment plan.
  • Rest when you’re tired and get enough sleep at night.
  • Gradually increase your activity level.
  • Avoid contact sports.
  • Avoid alcohol.

What is the outlook for an epidural hematoma?

Without prompt medical treatment, an epidural hematoma carries a high risk of death. Even with treatment, it can cause lasting brain damage and disability.

Prompt treatment increases your chances of survival and improves your recovery prospects. Following your doctor’s recommended treatment plan can also help you recover, while lowering your risk of complications and permanent disability.

How can you prevent epidural hematomas?

It’s not always possible to avoid accidents. As a result, head trauma and epidural hematomas can happen to anyone. But you can lower your risk of injury by taking a few simple safety precautions. For example:

  • Always wear a seat belt while travelling in a motor vehicle.
  • Always wear a properly fitted helmet while riding your bike, playing contact sports, or participating in other leisure or work activities with a high risk of head injury.
  • Keep your home, yard, and workplace in good repair to minimize tripping hazards and lower your risk of falls.

These basic precautions can help protect your head and brain from injury.

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