Epidural Hematoma

Written by Anna Zernone Giorgi | Published on September 23, 2013
Medically Reviewed by George Krucik, MD, MBA on September 23, 2013

What Is an Epidural Hematoma?

An epidural hematoma occurs when blood fills the area between the skull and the protective covering of the brain.

If the brain bounces against the inside of the skull during a collision, it can experience tearing of the internal lining, tissues, and blood vessels. This will result in bleeding. A mass of blood called a hematoma may form between the skull and brain. This epidural hematoma creates pressure on the brain.

There is no room in the skull for the brain to expand, so the brain may shift as it swells. The brain structures push together and create pressure, which can affect vision, speech, and consciousness. The brain may also lose blood supply and die.

If you suspect you have an epidural hematoma, you should get immediate medical care. Left untreated, an epidural hematoma can cause brain damage and eventually death.

What Causes Epidural Hematomas?

An epidural hematoma typically results from trauma or injury to the head. Your brain may be subjected to an intense, damaging blow in a fall, a vehicular accident, or a collision during contact sports, for example.

Who Is at Risk for an Epidural Hematoma?

You are at a higher risk for developing an epidural hematoma if you:

  • are elderly
  • have trouble walking without falling
  • have experienced trauma to your head
  • use alcohol, which can increase your risk of falls
  • take an blood thinning medication
  • do not wear a protective helmet during contact activities

What Are the Symptoms of an Epidural Hematoma?

Symptoms of an epidural hematoma depend on the severity of the brain injury. A common symptom is a brief period of unconsciousness. This is followed by a period of alert consciousness before returning to unconsciousness or even coma.

The following symptoms typically occur within minutes to hours after a head injury and may indicate an epidural hematoma:

  • confusion
  • dizziness
  • drowsiness
  • varying levels of alertness
  • severe headache
  • nausea
  • vomiting
  • seizures
  • enlarged pupil in one eye
  • weakness on one part of the body, typically on the side opposite the enlarged pupil
  • bruises around the eyes
  • bruises behind the ears
  • clear fluid draining from the nose or ears
  • shortness of breath or other changes in breathing patterns

How Is an Epidural Hematoma Diagnosed?

A physician will conduct a neurological test if he or she suspects an epidural hematoma. Further tests may be necessary to determine the size and position of a hematoma. Common tests are:

  • computed tomography (CT) scan to see fine details of the brain
  • magnetic resonance imaging (MRI) to examine soft tissue
  • electroencephalogram (EEG) to assess the brain’s electrical activity
  • laboratory blood tests

How Is an Epidural Hematoma Treated?

Treatment for an epidural hematoma depends on the severity of the brain injury, the presence of other injuries, and symptoms.

Medications

Your doctor may prescribe medications to reduce inflammation and intracranial pressure during the initial phase of treatment.

After removal of the hematoma, your doctor may prescribe anti-seizure medications to protect against seizures. These medications may be necessary for months or even years.

Other medications, called “hyperosmotic agents,” may be prescribed to reduce brain swelling. These drugs include mannitol, glycerol, and hypertonic saline.

Surgeries

Surgery is generally recommended to remove epidural hematomas. Symptoms that indicate a need for surgery generally include:

  • deterioration of brain function
  • severe headache
  • hematoma thicker than one centimeter at its thickest point

Surgery usually involves a craniotomy to open up part of the skull. This allows the surgeon to remove the clot and reduce pressure on the brain.

Aspiration, also called surgical drainage, can remove an epidural hematoma without surgery. This involves cutting a small hole in the skull to remove the clot with suction. Aspiration is effective for a very small epidural hematoma that is not causing pressure or damage to the surrounding tissue.

Home Care

Do not attempt to treat this condition at home. If you have experienced head trauma and have any symptoms of an epidural hematoma, seek immediate medical care.

After surgery, recovery can take time. Most improvement will occur within the first six months after the injury. Additional improvement may take up to two years.

Recommendations for home recovery will likely include:

  • Rest when you are tired.
  • Get a good night’s sleep.
  • Gradually return to normal activities.
  • Avoid contact and recreational sports.
  • Don’t drink alcohol.
  • Record important information until full memory skills return.

What Is the Outlook for an Epidural Hematoma?

Without prompt medical treatment, an epidural hematoma carries a high risk of death

Whether or not it is treated, an epidural hematoma also puts you at a high risk for brain damage. Brain damage can cause many types of disabilities, which can be permanent. You may require a rehabilitation program to deal with disabilities, such as:

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

After the injury and after surgery, you may experience seizures for up to two years.

Preventing Epidural Hematomas

An epidural hematoma can happen to anyone. Minimize your risk of head injury by taking safety precautions at home, at work, and during recreational activities. Basic recommended precautions are:

  • Wear a properly fitting helmet during contact sports or activities that could result in head injury.
  • Always use your seat belt in a motor vehicle.
  • Protect children from falls and blows to the head by properly childproofing your home.
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