Epidural hematoma physical examination

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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

Findings in physical examination of patients with epidural hematoma may vary depend on the site of hematoma. In patients with cranial epidural hematoma various focal neurologic signs may be seen depend on the site of hematoma. Physical examination of patients with cranial epidural hematoma is usually remarkable for loss of consciousness, unilateral diminished deep tendon reflexes, unilateral fixed mydriasis and abnormal pupillary reflex, down and out positioned eyes, loss of vision in contralateral side of hematoma and abnormal vertical gaze, unilaterally muscle weakness and unilateral sensory loss.

Glasgow coma scale in most patients with epidural hematoma is reduced. In patients with brain herniation due to the epidural hematoma respiratory arrest and Cushing's triad(hypertension, bradycardia, and irregular respiration) may be seen. Findings in neck examination of patients with spinal epidural hematoma is usually include stiffness and tenderness.

Physical Examination

• Findings in physical examination of patients with epidural hematoma may vary depend on the site of hematoma.
• In patients with cranial epidural hematoma various focal neurologic signs may be seen depend on the site of hematoma.
• Physical examination of patients with cranial epidural hematoma is usually remarkable for loss of consciousness, unilateral diminished deep tendon reflexes, unilateral fixed mydriasis and abnormal pupillary reflex, down and out positioned eyes, loss of vision in contralateral side of hematoma and abnormal vertical gaze, unilaterally muscle weakness and unilateral sensory loss.
• Glasgow coma scale in most patients with epidural hematoma is reduced.

• In patients with brain herniation due to the epidural hematoma respiratory arrest and Cushing's triad(hypertension, bradycardia, and irregular respiration) may be seen.
• Findings in neck examination of patients with spinal epidural hematoma is usually include stiffness and tenderness.

Appearance of the Patient

• Patients with epidural hematoma usually appear ill and confused and may have sever pain.

Vital Signs

• Bradycardia with regular pulse may be seen.
• Tachypnea and irregular respiration may be present.
• High blood pressure with normal pulses pressure may be seen.

Skin

• Pallor may be present.

HEENT

Findings in HEENT examination of patients with epidural hematoma may include:

• Evidence of trauma
• Icteric sclera
• Nystagmus
• Abnormal extra-ocular eye movements
• Non-reactive pupils to light and to accommodation
• Hearing acuity may be reduced
• Weber test may be abnormal
• Tenderness upon palpation of the scalp
• Facial tenderness

Neck

• Findings in neck examination of patients with spinal epidural hematoma is usually include:
• Stiffness
• Tenderness

Heart

• Patients with epidural hematoma may have tachycardia or bradycardia.

Abdomen

• Abdominal examination of patients with epidural hematoma is usually normal.

Back

• In patients with spinal epidural hematoma point tenderness over the vertebral column may be present.

Genitourinary

• Genitourinary examination of patients with epidural hematoma is usually normal.

Neuromuscular

• Neuromuscular examination of patients with epidural hematoma may be remarkable for:
  • loss of orientation to persons, place, and time.
  • Altered mental status
  • Low glasgow coma scale
  • Clonus
  • Hyperreflexia
  • Unilaterally positive (abnormal) Babinski reflex
  • Muscle rigidity
  • Unilaterally muscle weakness
  • Nystagmus
  • Abnormal extra-ocular movements
  • Non-reactive pupils to light and to accommodation
  • Unilateral sensory loss
  • Abnormal gait