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==Overview==
==Overview==
If left untreated, [#]% of patients with epidural hematoma may progress to develop permanent paraplegia, [manifestation 2], and death.


OR
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
OR
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==


===Natural History===
===Natural History===
*The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___.
*If left untreated, patients with epidural hematoma may progress to develop permanent [[paraplegia]], loss of [[sensation]], [[brain herniation]], [[coma]] and death.<ref name="pmid15219302" /><ref name="pmid28824860" /><ref name="pmid21069508" /><ref name="pmid28966825" /><ref name="pmid28587706" />
*The symptoms of (disease name) typically develop ___ years after exposure to ___.
*If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].


===Complications===
===Complications===
*Common complications of epidural hematoma include:
*Common complications of epidural hematoma include:
**Brain herniation<ref name="pmid28966825">{{cite journal| author=Ben-Israel D, Isaacs AM, Morrish W, Gallagher NC| title=Acute vertex epidural hematoma. | journal=Surg Neurol Int | year= 2017 | volume= 8 | issue=  | pages= 219 | pmid=28966825 | doi=10.4103/sni.sni_218_17 | pmc=5609442 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28966825  }} </ref>
**[[Brain herniation]]<ref name="pmid28966825">{{cite journal| author=Ben-Israel D, Isaacs AM, Morrish W, Gallagher NC| title=Acute vertex epidural hematoma. | journal=Surg Neurol Int | year= 2017 | volume= 8 | issue=  | pages= 219 | pmid=28966825 | doi=10.4103/sni.sni_218_17 | pmc=5609442 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28966825  }} </ref>
**Death<ref name="pmid25878757">{{cite journal| author=Chakraborty S, Dey PK, Chatterjee S| title=Cranial epidural hematoma related to an accidental fall from mother's lap in a neonate. | journal=J Pediatr Neurosci | year= 2015 | volume= 10 | issue= 1 | pages= 82-3 | pmid=25878757 | doi=10.4103/1817-1745.154370 | pmc=4395959 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25878757  }} </ref>
**Death<ref name="pmid25878757">{{cite journal| author=Chakraborty S, Dey PK, Chatterjee S| title=Cranial epidural hematoma related to an accidental fall from mother's lap in a neonate. | journal=J Pediatr Neurosci | year= 2015 | volume= 10 | issue= 1 | pages= 82-3 | pmid=25878757 | doi=10.4103/1817-1745.154370 | pmc=4395959 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25878757  }} </ref>
**Post-traumatic seizures<ref name="pmid1738023">{{cite journal| author=Lee ST, Lui TN| title=Early seizures after mild closed head injury. | journal=J Neurosurg | year= 1992 | volume= 76 | issue= 3 | pages= 435-9 | pmid=1738023 | doi=10.3171/jns.1992.76.3.0435 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1738023  }} </ref>
**Post-traumatic [[Seizure|seizures]]<ref name="pmid1738023">{{cite journal| author=Lee ST, Lui TN| title=Early seizures after mild closed head injury. | journal=J Neurosurg | year= 1992 | volume= 76 | issue= 3 | pages= 435-9 | pmid=1738023 | doi=10.3171/jns.1992.76.3.0435 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1738023  }} </ref>
**Infarction of the brain tissue which may cause:
**[[Infarction]] of the [[brain tissue]] which may cause:
***Visual problems<ref name="pmid18827272">{{cite journal| author=Ulrich PT, Fuessler H, Januschek E| title=Acute epidural hematoma with infarction of the right hemisphere in a 5-month-old child: case report with a long-term follow-up and a review of the literature. | journal=J Child Neurol | year= 2008 | volume= 23 | issue= 9 | pages= 1066-9 | pmid=18827272 | doi=10.1177/0883073808315411 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18827272  }} </ref>
***Visual problems<ref name="pmid18827272">{{cite journal| author=Ulrich PT, Fuessler H, Januschek E| title=Acute epidural hematoma with infarction of the right hemisphere in a 5-month-old child: case report with a long-term follow-up and a review of the literature. | journal=J Child Neurol | year= 2008 | volume= 23 | issue= 9 | pages= 1066-9 | pmid=18827272 | doi=10.1177/0883073808315411 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18827272  }} </ref>
***Persistent paraplegia<ref name="pmid28824860">{{cite journal| author=Anipindi S, Ibrahim N| title=Epidural Haematoma Causing Paraplegia in a Patient with Ankylosing Spondylitis: A Case Report. | journal=Anesth Pain Med | year= 2017 | volume= 7 | issue= 2 | pages= e43873 | pmid=28824860 | doi=10.5812/aapm.43873 | pmc=5559664 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28824860  }} </ref><ref name="pmid21069508">{{cite journal| author=Gogarten W, Hoffmann K, Van Aken H| title=[Recommendations for the administration of conventional and new antithrombotic agents from the perspective of anesthesiology]. | journal=Unfallchirurg | year= 2010 | volume= 113 | issue= 11 | pages= 908-14 | pmid=21069508 | doi=10.1007/s00113-010-1881-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21069508  }} </ref>
***Persistent [[paraplegia]]<ref name="pmid28824860">{{cite journal| author=Anipindi S, Ibrahim N| title=Epidural Haematoma Causing Paraplegia in a Patient with Ankylosing Spondylitis: A Case Report. | journal=Anesth Pain Med | year= 2017 | volume= 7 | issue= 2 | pages= e43873 | pmid=28824860 | doi=10.5812/aapm.43873 | pmc=5559664 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28824860  }} </ref><ref name="pmid21069508">{{cite journal| author=Gogarten W, Hoffmann K, Van Aken H| title=[Recommendations for the administration of conventional and new antithrombotic agents from the perspective of anesthesiology]. | journal=Unfallchirurg | year= 2010 | volume= 113 | issue= 11 | pages= 908-14 | pmid=21069508 | doi=10.1007/s00113-010-1881-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21069508  }} </ref>
***Coma<ref name="pmid28587706">{{cite journal| author=Firsching R| title=Coma After Acute Head Injury. | journal=Dtsch Arztebl Int | year= 2017 | volume= 114 | issue= 18 | pages= 313-320 | pmid=28587706 | doi=10.3238/arztebl.2017.0313 | pmc=5465842 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28587706  }} </ref>
***[[Coma]]<ref name="pmid28587706">{{cite journal| author=Firsching R| title=Coma After Acute Head Injury. | journal=Dtsch Arztebl Int | year= 2017 | volume= 114 | issue= 18 | pages= 313-320 | pmid=28587706 | doi=10.3238/arztebl.2017.0313 | pmc=5465842 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28587706  }} </ref>
***Loss of sensation<ref name="pmid15219302">{{cite journal| author=Cuenca PJ, Tulley EB, Devita D, Stone A| title=Delayed traumatic spinal epidural hematoma with spontaneous resolution of symptoms. | journal=J Emerg Med | year= 2004 | volume= 27 | issue= 1 | pages= 37-41 | pmid=15219302 | doi=10.1016/j.jemermed.2004.02.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15219302  }} </ref>
***Loss of sensation<ref name="pmid15219302">{{cite journal| author=Cuenca PJ, Tulley EB, Devita D, Stone A| title=Delayed traumatic spinal epidural hematoma with spontaneous resolution of symptoms. | journal=J Emerg Med | year= 2004 | volume= 27 | issue= 1 | pages= 37-41 | pmid=15219302 | doi=10.1016/j.jemermed.2004.02.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15219302  }} </ref>
***Priapism<ref name="pmid15219302">{{cite journal| author=Cuenca PJ, Tulley EB, Devita D, Stone A| title=Delayed traumatic spinal epidural hematoma with spontaneous resolution of symptoms. | journal=J Emerg Med | year= 2004 | volume= 27 | issue= 1 | pages= 37-41 | pmid=15219302 | doi=10.1016/j.jemermed.2004.02.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15219302  }} </ref>
***Priapism<ref name="pmid15219302">{{cite journal| author=Cuenca PJ, Tulley EB, Devita D, Stone A| title=Delayed traumatic spinal epidural hematoma with spontaneous resolution of symptoms. | journal=J Emerg Med | year= 2004 | volume= 27 | issue= 1 | pages= 37-41 | pmid=15219302 | doi=10.1016/j.jemermed.2004.02.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15219302  }} </ref>
**Disturbed circulation of the cerebrospinal fluid<ref name="pmid1233608">{{cite journal| author=Fuchs EC, Müller-Busch C, Amtenbrink V| title=[Prognosis and long-term prognosis of epidural haematoma (a study of 83 patients) (author's transl)]. | journal=Rehabilitation (Stuttg) | year= 1975 | volume= 14 | issue= 2 | pages= 82-7 | pmid=1233608 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1233608  }} </ref>
**Disturbed circulation of the cerebrospinal fluid<ref name="pmid1233608">{{cite journal| author=Fuchs EC, Müller-Busch C, Amtenbrink V| title=[Prognosis and long-term prognosis of epidural haematoma (a study of 83 patients) (author's transl)]. | journal=Rehabilitation (Stuttg) | year= 1975 | volume= 14 | issue= 2 | pages= 82-7 | pmid=1233608 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1233608  }} </ref>
**Urinary retention<ref name="pmid18379155">{{cite journal| author=Sakakibara R, Yamazaki M, Mannouji C, Yamaguchi C, Uchiyama T, Ito T et al.| title=Urinary retention without tetraparesis as a sequel to spontaneous spinal epidural hematoma. | journal=Intern Med | year= 2008 | volume= 47 | issue= 7 | pages= 655-7 | pmid=18379155 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18379155  }} </ref>
**[[Urinary retention]]<ref name="pmid18379155">{{cite journal| author=Sakakibara R, Yamazaki M, Mannouji C, Yamaguchi C, Uchiyama T, Ito T et al.| title=Urinary retention without tetraparesis as a sequel to spontaneous spinal epidural hematoma. | journal=Intern Med | year= 2008 | volume= 47 | issue= 7 | pages= 655-7 | pmid=18379155 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18379155  }} </ref>


===Prognosis===
===Prognosis===
*Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
* Prognosis is generally good in patients treated surgically without delay.
*Depending on the extent of the [tumor/disease progression/etc.] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent.
* In patients with acute epidural hematoma the surgery in an interval under two hours leads to 17% mortality rate and 67% of good recoveries but in patients who recover after an interval of more than two hours the mortality rate is 65% and good recovery rate is 13%.
*The presence of [characteristic of disease] is associated with a particularly [good/poor] prognosis among patients with [disease/malignancy].
* Overall mortality rate of patients with epidural hematoma is approximately 25%.
*[Subtype of disease/malignancy] is associated with the most favorable prognosis.
* The percentages of overall good recoveries and minimal neurologic deficit in patients with epidural hematoma is approximately 58%.
*The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis.
 
* The prognosis is worse in older patients and in patients with concomitant injuries of other body regions.


==References==
==References==
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[[Category: (name of the system)]]
[[Category: (name of the system)]]   
 
== Overview ==
 
== Natural history ==
 
Epidural bleeds, like [[subdural hematoma|subdural]] and [[subarachnoid hemorrhage]]s, are [[extra-axial hemorrhage|extra-axial bleeds]], occurring outside of the brain tissue, while [[intra-axial hemorrhage]]s, including [[intraparenchymal hemorrhage|intraparenchymal]] and [[intraventricular hemorrhage]]s, occur within it.<ref>Wagner AL. 2006. [http://www.emedicine.com/radio/topic664.htm "Subdural Hematoma."] Emedicine.com. Retrieved on February 6, 2007. </ref> 10% of epidural bleeds may be venous.<ref name="Shepherd">Shepherd S. 2004. [http://www.emedicine.com/med/topic2820.htm "Head Trauma."] Emedicine.com. Retrieved on February 6, 2007.</ref>
 
Epidural bleeding is rapid because it is usually from arteries, which are high pressure. Epidural bleeds from arteries can  grow until they reach their peak size at six to eight hours post injury, spilling from 25 to 75 cubic centimeters of blood into the [[intracranial space]].<ref name="uv">University of Vermont College of Medicine. [http://web.archive.org/web/20050309165318/http://cats.med.uvm.edu/cats_teachingmod/pathology/path302/np/home/neuroindex.html "Neuropathology: Trauma to the CNS."] Accessed through web archive.  Retrieved on February 6, 2007.</ref>  As the hematoma expands, it strips the dura from the inside of the skull, causing an intense headache.
 
== Complications ==
 
* There is a risk of permanent brain injury whether the disorder is treated or untreated. Symptoms (such as seizures) may persist for several months, even after treatment, but in time they usually become less frequent or disappear completely. [[Seizure (patient information)|Seizures]] may begin as many as 2 years after the injury.
 
* In adults, most recovery occurs in the first 6 months, with some improvement over approximately 2 years. Children usually recover more quickly and completely than adults.
 
* Incomplete recovery is the result of brain damage. Other complications include permanent symptoms (such as [[paralysis]] or loss of sensation, which began at the time of the injury), herniation of the brain (which may result in permanent [[Coma (patient information)|coma]]), and [[Normal pressure hydrocephalus (patient information)|normal pressure hydrocephalus]] (excess fluid in the cavities of the brain).
 
*Epidural bleeds can become large and raise [[intracranial pressure]], causing the brain to shift, lose blood supply, or be crushed against the skull. Larger hematomas cause more damage.  Epidural bleeds can quickly expand and compress the brain stem, causing [[coma|unconsciousness]], [[abnormal posturing]], and abnormal [[pupil]] responses to light.<ref name="singh Stock">Singh J and Stock A. 2006. [http://www.emedicine.com/ped/topic929.htm "Head Trauma."] Emedicine.com. Retrieved on February 6, 2007.</ref> Epidural hematomas may occur in combination with subdural hematomas, or either may occur alone.<ref name="Shepherd" /> CT scans reveal subdural or epidural hematomas in 20% of unconscious patients.<ref name="Downie">Downie A. 2001. [http://www.radiology.co.uk/srs-x/tutors/cttrauma/tutor.htm "Tutorial: CT in Head Trauma"]. Retrieved on February 6, 2007.</ref>
 
== Prognosis ==
 
In the hallmark of epidural hematoma, patients may regain consciousness during what is called a [[lucid interval]], only to descend suddenly and rapidly into unconsciousness later.  The lucid interval, which depends on the extent of the injury, is a key to diagnosing epidural hemorrhage.  If the patient is not treated with prompt surgical intervention, death is likely to follow.<ref name="Caroline">Caroline NL. 1991.  ''Emergency Medical Treatment''. Little Brown & Company.</ref>
<gallery>
Image:epidural hematoma.jpg|Epidural Hematoma <ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages</ref>
Image:Epidural_hematoma2.jpg|Epidural hematomas usually look convex on CT scans
Image:Skull interior anatomy.svg|The interior of the skull has sharp ridges by which a moving brain can be injured.
</gallery>
 
'''Patient#1'''
<gallery>
Image:
 
Epidural hematoma 201.jpg
 
</gallery>
 
'''Patient#2'''
<gallery>
Image:Epidural-hematoma-001.jpg|CT: Epidural hematoma
Image:Epidural-hematoma-002.jpg|CT: Epidural hematoma
</gallery>


'''Patient#3'''
<gallery>
<gallery>
Image:Epidural-hematoma-201.jpg|CT: Epidural hematoma
Image:Epidural-hematoma-201.jpg|CT: Epidural hematoma

Revision as of 14:44, 11 June 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

  • Prognosis is generally good in patients treated surgically without delay.
  • In patients with acute epidural hematoma the surgery in an interval under two hours leads to 17% mortality rate and 67% of good recoveries but in patients who recover after an interval of more than two hours the mortality rate is 65% and good recovery rate is 13%.
  • Overall mortality rate of patients with epidural hematoma is approximately 25%.
  • The percentages of overall good recoveries and minimal neurologic deficit in patients with epidural hematoma is approximately 58%.
  • The prognosis is worse in older patients and in patients with concomitant injuries of other body regions.

References

  1. ↑ 1.0 1.1 1.2 Cuenca PJ, Tulley EB, Devita D, Stone A (2004). "Delayed traumatic spinal epidural hematoma with spontaneous resolution of symptoms". J Emerg Med. 27 (1): 37–41. doi:10.1016/j.jemermed.2004.02.008. PMID 15219302.
  2. ↑ 2.0 2.1 Anipindi S, Ibrahim N (2017). "Epidural Haematoma Causing Paraplegia in a Patient with Ankylosing Spondylitis: A Case Report". Anesth Pain Med. 7 (2): e43873. doi:10.5812/aapm.43873. PMC 5559664. PMID 28824860.
  3. ↑ 3.0 3.1 Gogarten W, Hoffmann K, Van Aken H (2010). "[Recommendations for the administration of conventional and new antithrombotic agents from the perspective of anesthesiology]". Unfallchirurg. 113 (11): 908–14. doi:10.1007/s00113-010-1881-x. PMID 21069508.
  4. ↑ 4.0 4.1 Ben-Israel D, Isaacs AM, Morrish W, Gallagher NC (2017). "Acute vertex epidural hematoma". Surg Neurol Int. 8: 219. doi:10.4103/sni.sni_218_17. PMC 5609442. PMID 28966825.
  5. ↑ 5.0 5.1 Firsching R (2017). "Coma After Acute Head Injury". Dtsch Arztebl Int. 114 (18): 313–320. doi:10.3238/arztebl.2017.0313. PMC 5465842. PMID 28587706.
  6. ↑ Chakraborty S, Dey PK, Chatterjee S (2015). "Cranial epidural hematoma related to an accidental fall from mother's lap in a neonate". J Pediatr Neurosci. 10 (1): 82–3. doi:10.4103/1817-1745.154370. PMC 4395959. PMID 25878757.
  7. ↑ Lee ST, Lui TN (1992). "Early seizures after mild closed head injury". J Neurosurg. 76 (3): 435–9. doi:10.3171/jns.1992.76.3.0435. PMID 1738023.
  8. ↑ Ulrich PT, Fuessler H, Januschek E (2008). "Acute epidural hematoma with infarction of the right hemisphere in a 5-month-old child: case report with a long-term follow-up and a review of the literature". J Child Neurol. 23 (9): 1066–9. doi:10.1177/0883073808315411. PMID 18827272.
  9. ↑ Fuchs EC, Müller-Busch C, Amtenbrink V (1975). "[Prognosis and long-term prognosis of epidural haematoma (a study of 83 patients) (author's transl)]". Rehabilitation (Stuttg). 14 (2): 82–7. PMID 1233608.
  10. ↑ Sakakibara R, Yamazaki M, Mannouji C, Yamaguchi C, Uchiyama T, Ito T; et al. (2008). "Urinary retention without tetraparesis as a sequel to spontaneous spinal epidural hematoma". Intern Med. 47 (7): 655–7. PMID 18379155.

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  • CT: Epidural hematoma
    CT: Epidural hematoma

References

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