In adults, the temporal region accounts for 75% of cases. A venous hematoma may be acute (occurring within a day of the injury and appearing as a swirling mass of blood without a clot), subacute (occurring in 2–4 days and appearing solid), or chronic (occurring in 7–20 days and appearing mixed or lucent). In 10% of cases, however, it comes from veins and can progress more slowly. The break of the temporal bone causes bleeding from the middle meningeal artery, hence epidural bleeding is often rapid as arteries are high-pressure flow. The hematoma can be seen on autopsy as brick red, or as radiolucent on CT scan, because of heat-induced coagulation of the hematoma. Ī "heat hematoma" is an epidural hematoma caused by severe thermal burn, causing contraction and exfoliation of the dura mater and exfoliate from the skull, in turn causing exudation of blood from the venous sinuses. Epidural hematoma is usually found on the same side of the brain which was impacted by the blow, but on very rare occasions it can be due to a contrecoup injury. The brain may be injured by prominences on the inside of the skull as it scrapes past them. Only 20 to 30% of epidural hematomas occur outside the region of the temporal bone. The pterion region, which overlies the middle meningeal artery, is relatively weak and prone to injury. Įpidural hematoma commonly results from a blow to the side (temporal bone) of the head.
They are often caused by acceleration-deceleration trauma and transverse forces. Epidural hematomas occur in about 10% of traumatic brain injuries, mostly due to car accidents, assaults, or falls. The most common cause of intracranial epidural hematoma is head injury, although spontaneous hemorrhages have been known to occur. The interior of the skull has sharp ridges by which a moving brain can be injured. In the case of epidural hematoma in the posterior cranial fossa, tonsillar herniation causes Cushing's triad: hypertension, bradycardia, and irregular breathing. The trigeminal nerve may be involved late in the process as the pons is compressed, but this is not an important presentation, because the person may already be dead by the time it occurs. If not treated promptly, epidural hematomas can cause tonsillar herniation, resulting in respiratory arrest. In rare cases, small hematomas may be asymptomatic. Other symptoms include severe headache weakness of the extremities on the opposite side from the lesion due to compression of the crossed pyramid pathways and vision loss, also on the opposite side, due to compression of the posterior cerebral artery. The eye will be positioned down and out due to unopposed innervation of the fourth and sixth cranial nerves. As blood accumulates, it starts to compress intracranial structures, which may impinge on the third cranial nerve, causing a fixed and dilated pupil on the side of the injury. Because of this initial period of lucidity, it has been called "Talk and Die" syndrome. Many people with epidural hematomas experience a lucid period immediately following the injury, with a delay before symptoms become evident.
Males are more often affected than females. The condition occurs in one to four percent of head injuries. Without treatment, death typically results. Treatment is generally by urgent surgery in the form of a craniotomy or burr hole. When this condition occurs in the spine it is known as a spinal epidural hematoma. Diagnosis is typically by a CT scan or MRI. Occasionally it can occur as a result of a bleeding disorder or blood vessel malformation. The cause is typically head injury that results in a break of the temporal bone and bleeding from the middle meningeal artery. Other symptoms may include headache, confusion, vomiting, and an inability to move parts of the body. Often there is loss of consciousness following a head injury, a brief regaining of consciousness, and then loss of consciousness again. Subdural hematoma, subarachnoid hemorrhage, traumatic brain injury, transient ischemic attack seizure, intracranial abscess, brain tumor Įpidural hematoma is when bleeding occurs between the tough outer membrane covering the brain (dura mater) and the skull. Head injury, bleeding disorder, blood vessel malformation There is also bruising with bleeding on the opposite side of the brain. Note the biconvex shaped collection of blood. Extradural hematoma, epidural hemorrhage, epidural haematoma, epidural bleedingĮpidural hematoma as seen on a CT scan with overlying skull fracture.
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