5.1 Epidural Hematomas

Case Study

29 year old male was involved in a single vehicle rollover collision.  He was not wearing a seatbelt and was ejected from the vehicle.  He sustained severe facial fractures, a closed head injury and multiple orthopedic fractures.  He was airlifted to hospital and on arrival had a GCS of 13.  He was subsequently intubated because of a deteriorating GCS.  CT scan showed a larger right frontal subdural/epidural hemorrhage with midline shift and uncal herniation.  He required multiple surgeries for his orthopedic and facial fractures.  He was taken to the OR for a right sided decompressive craniotomy.  Intraoperatively they reported a large epidural hematoma; bone flap was left off and replaced one month later.

Case Study continued

The patient was admitted to rehabilitation 6 weeks after his injury. At that time he was alert, with short-term memory difficulties, subtle difficulties with word finding and higher level tasks. CT scan of his head demonstrated bilateral inferior frontal lobe and left temporal lobe contusions with hypodensity of the brain compatible with encephalomalacic change in addition to an extradural fluid collection in the right frontal region which indented the underlying brain.

What is the etiology of epidural hematomas?

  1. Result of head trauma, usually associated with skull fracture, with laceration of dural veins and arteries.
     
  2. Usually associated with a tear of the middle meningeal artery.
  • An epidural hematoma is defined as an accumulation of blood in the potential space between dura and bone.
     
  • An intracranial epidural hematoma has been found to occur in approximately 2% of patients who sustain a brain injury and 5-15% of those who sustain a fatal head injury.
     
  • Once diagnosed, surgical interventions are needed.
     
  • Link to diagram of SDH

 

How do epidural hematomas typically present?

  1. Half of the patients present with the classical picture of a lucid period followed by clinical deterioration.

What is the general prognosis of epidural hematomas?

  1. The underlying brain injury is often not severe if treated promptly.
     
  2. If due to an arterial laceration an epidural hematoma can evolve rapidly and lead to deterioration and even death.
     
  3. If detected early, mortality is less than 10%.