Epidural Hematoma | Western Sydney University

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

311

Pages:

5
Author:

Mariam A. A.

Epidural Hematoma Definition Also known as extradural hematoma Haemorrhage between dura matter and inner surface of the skull Epidemiology Most common in 20- to 30-year-olds Most common in males Causes Most are due to a rupture of the middle meningeal artery Trauma Most common Non-traumatic Infections Coagulopathoes Dural vascular malformations Dural metastases Locations/Sources Arterial (common) Venous (rare) MMA MMV Brach of the maxillary artery Dural sinus injury Most common source Sites of rupture Rupture of a dural vascular malformation Pterion Sites of rupture Most common Posterior fossa Thinnest part of the skull and is where the MMA lies in close proximity to the skull Middle cranial fossa Vertex Skull base Clinical Features Initial loss of consciousness after injury Decline in neurological status Hematoma expansion and mass effect C/L focal neurological deficits Features of raised ICP headache and Cushing triad Unrelieved brain stem compression Coma and death Ipsilateral oculomotor nerve compression Loss of PSNS supply to pupillary sphincter I/D dilated pupil (anisocoria) L/L hemiparesis Pupillary abnormalities signs of uncal herniation Anisocoria with I/L mydriasis most common U/L or B/L fixed dilated pupils C/L or B/L mydriasis Signs of cerebral herniation syndrome Ataxia Seizures CN deficits Reduced CGS Investigations Labs Coagulopathies CT without IV contrast First line Ix Findings: Biconvex/lenticular shape Mass effect Midline deviation Subfalcine herniation Ventricular compression Unlike subdural hematomas they do not cross cranial sutures suture lines present (because the dura has a firm attachment) MRI without IV contrast Have a suspected small epidural hematoma DDx Subdural hematoma SAH ICH Management ABCDE Conservative management Admission to neuro-ICU Frequent GCS monitoring ad neurological checks for at least 72 hours Serial CT scans Serial CT scans to monitor for early hematoma expansion Indicated when there are no indications for surgical management Neurosurgical emergency Because the hematoma can rapidly expand brain herniation and death Indications: Volume of more than 30 mL regardless of GCS More than 15 mm thickness Midline shift of more than 5mm GCS of 8 or less Evidence of neuro deterioration Pupillary abnormalities Signs of brain herniation Associated brain injuries Procedures 1 st line: Craniotomy, hematoma evacuation and ligation of ruptured blood vessel 2 nd line: emergency temporizing procedure skull trephination Complications Permanent neurological deficits Paralysis Cognitive impairment Increased ICP brain herniation Most common Seizures Coma Infections e.g. meningitis Recurrence Surgical complications Rapid deterioration Prognosis If there are no other associated brain injury early decompression good neurological outcomes Factors associated with poor prognosis: Aged more than 75 Large volume hematoma significant midline shift Associated brain injuries GCS of 8 or less at presentation Pupillary abnormalities Prolonged period of time between herniation and decompressive surgery