Epidural Hematoma

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[edit] Epidural hematoma

This is another cause of a headache, which usually has a traumatic origin. A blow to the head with a hard object or getting up and banging the head against an overhead cupboard or a heavy shelf could cause a fracture line in the temporal bone of the skull. Right adjacent to this bone is the middle meningeal artery that can get damaged this way.

Blood can accumulate in the space between the skull and the hard membrane lining called "dura mater". Images of head injuries in children with an epidural hematoma are shown in this link(scroll down for images).

Symptoms:

This epidural hematoma causes slow pressure onto the brain and there is an initial "lucid iterval", in which the patient is conscious and thinks perhaps that other than a headache nothing much has happened.

A few hours (typically 3 to 8 hours) later though the patient who complained about a severe headache all along, will pass out and turn unconscious. Prior to this there may have been a sudden fall from a loss of muscle power.

This coma is caused by increasing intracranial pressure. The pupils often are fixed and dilated, a poor prognostic sign, if surgical evacuation of the epidural hematoma is not done very quickly. Diagnostic X-ray films sometimes show a temporal bone fracture line or an emergency CT or MRI scan will show the neurosurgeon the location of the epidural hematoma.

Treatment:

A surgical burr hole is placed right over the center of the hematoma and the surgeon literally wakes up the patient within a short period of time. The coma is reversed and in a day or two the patient can go home. Left untreated, death would be almost certain. Although epidural hematomas are less common than subdural hematomas, quick action of everybody around the patient is very important. The sequence of events should be: Calling an ambulance, rushing to the hospital, telling the staff the exact history, mentioning a blow to the head followed by a "lucid interval". Some tests will confirm the condition and surgery will follow immediately.

Home page

Neurological disease

Common causes of headaches

References:

1. Goldman: Cecil Textbook of Medicine, 21st ed.,2000, W. B. Saunders Company

2. B. Sears: "The top 100 zone foods". Regan Books, Harper Collins, 2001.

3. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 176.

4. Noble: Textbook of Primary Care Medicine, 3rd ed.,2001, Mosby, Inc.

5. Goroll: Primary Care Medicine, 4th ed.,2000, Lippincott Williams & Wilkins

6.Rosen: Emergency Medicine: Concepts and Clinical Practice, 4th ed., 1998, Mosby-Year Book, Inc.

7. Ruddy: Kelley's Textbook of Rheumatology, 6th ed.,2001, W. B. Saunders Company

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