Epidural hematoma natural history, complications and prognosis: Difference between revisions
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== Complications == | == Complications == | ||
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> | * 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 == | == Prognosis == | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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