Epidural hematoma (bleeding outside the brain)

Head | Neurology | Epidural hematoma (bleeding outside the brain) (Disease)


The dura is the lining that surrounds the brain and spinal cord. Epidural bleeds, like subdural and subarachnoid hemorrhages, are extra-axial bleeds, occurring outside of the brain tissue, while intra-axial hemorrhages, including intraparenchymal and intraventricular hemorrhages, occur within it.

Other manifestations will include weakness of the extremities on the same side as the lesion, due to compression of the crus on the opposite side of the lesion, and a loss of visual field opposite to the side of the lesion, due to compression of the posterior cerebral artery on the side of the lesion.

Causes and Risk factors

A person with an epidural hematoma has a collection of blood between the dura and the skull. The collection of blood places pressure against the brain, which can cause the brain to malfunction. Epidural hematomas are rare, and are most commonly caused by a head injury.

Fractures of the temporal bone, a thinner portion of the skull (at the temple), are commonly associated with epidural hematoma. Epidural hematomas may also be present along the spinal cord where they can cause epidural compression syndrome.

Diagnosis and Treatment

Epidural hematomas may present with a lucid period immediately following the trauma and a delay before symptoms become evident. After the epidural hematoma begins collecting, it starts to compress intracranial structures which may impinge on the CN III. This can be seen in the physical exam as a fixed and dilated pupil on the side of the injury. The eye will be positioned down and out, due to unopposed CN VI innervation.

Drainage of the blood is necessary and requires surgery. Medications to prevent seizures are given, and any blood clotting abnormalities are reversed. If the brain swelling is severe medications to reduce the swelling (mannitol) may be administered. ...

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