Epidural hematoma natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
If left untreated, [#]% of patients with epidural hematoma may progress to develop permanent paraplegia, [manifestation 2], and death. | If left untreated, [#]% of patients with epidural hematoma may progress to develop permanent paraplegia, [manifestation 2], and death. | ||
OR | OR | ||
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*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> | |||
**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 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> | ***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> | ||
Revision as of 17:06, 7 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
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
- The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___.
- 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
- Common complications of epidural hematoma include:
Prognosis
- Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
- 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.
- The presence of [characteristic of disease] is associated with a particularly [good/poor] prognosis among patients with [disease/malignancy].
- [Subtype of disease/malignancy] is associated with the most favorable prognosis.
- The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis.
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 8.0 8.1 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.
- ↑ 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.
- ↑ 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.
Overview
Natural history
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.[1] 10% of epidural bleeds may be venous.[2]
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.[3] 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. 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), and 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 unconsciousness, abnormal posturing, and abnormal pupil responses to light.[4] Epidural hematomas may occur in combination with subdural hematomas, or either may occur alone.[2] CT scans reveal subdural or epidural hematomas in 20% of unconscious patients.[5]
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.[6]
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![Epidural Hematoma [7]](/images/c/cd/Epidural_hematoma.jpg)
Epidural Hematoma [7] -
Epidural hematomas usually look convex on CT scans -
The interior of the skull has sharp ridges by which a moving brain can be injured.
![Epidural Hematoma [7]](/index.php/File:Epidural_hematoma.jpg)
Patient#1
Patient#2
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CT: Epidural hematoma -
CT: Epidural hematoma
Patient#3
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CT: Epidural hematoma
References
- ↑ Wagner AL. 2006. "Subdural Hematoma." Emedicine.com. Retrieved on February 6, 2007.
- ↑ 2.0 2.1 Shepherd S. 2004. "Head Trauma." Emedicine.com. Retrieved on February 6, 2007.
- ↑ University of Vermont College of Medicine. "Neuropathology: Trauma to the CNS." Accessed through web archive. Retrieved on February 6, 2007.
- ↑ Singh J and Stock A. 2006. "Head Trauma." Emedicine.com. Retrieved on February 6, 2007.
- ↑ Downie A. 2001. "Tutorial: CT in Head Trauma". Retrieved on February 6, 2007.
- ↑ Caroline NL. 1991. Emergency Medical Treatment. Little Brown & Company.
- ↑ http://picasaweb.google.com/mcmumbi/USMLEIIImages