EPIDURAL HEMATOMA

Outside the dura

An epidural hematoma is a type of traumatic brain bleeding. Here the blood collects between the skull and dura. 

Causes?

Always head trauma. The skull must be fractured. What commoners call the “temple” is in fact named the pterion, and this is a very thin part of the skull that is quite fragile. Easily fractured. The sharp edges of broken bone can cut a blood vessel. 

Where does the blood come from?

Usually from the Middle Meningeal Artery, a branch of the external carotid which runs underneath the pterion. 

Symptoms?

You must consider an epidural hematoma in anyone that sustains head trauma. If they passed out, raise your index of suspicion. They will often be asymptomatic following the injury for about a few minutes (lucid interval). As the hematoma expands, the ICP will rise. They will get a worsening headache. They will usually vomit. They might become drowsy and confused. They might begin to exhibit a focal neurological D=deficit, like arm weakness. Eventually they might begin to posture (involuntary full body muscle contractions), at which point they are unlikely to survive. 

Diagnosis and treatment?

Always diagnosed by noncontrast CT. The blood lights up as a bright white patch in a characteristic lens shape. The hematoma DOES NOT cross any suture lines because the dura is firmly welded to the skull at those sites. Treat with burr holes or a craniotomy to establish drainage. Early treatment is pretty effective.