Definition

Three protective membranes called the meninges surround the brain and spinal cord . The outermost layer, the dura mater, lies next to the inside of the skull. An epidural hematoma, also called a hemorrhage or a bleed, occurs when there is bleeding between the dura and the skull. The blood can pool, quickly causing an increase in intracranial pressure.

A distinguishing feature of epidural hematoma is the lucid interval. The patient experiences a loss of consciousness, recovers for a time, but then begins to deteriorate. This is a sign of increasing intracranial pressure and requires immediate surgical intervention. Epidural hematoma can also occur in the spinal column, leading to motor deficits and other peripheral neurological symptoms.

Treatment for this condition can be successful with excellent outcomes, when correctly and promptly identified. Untreated, it can lead to brain damage and death.

Causes

Blunt trauma, as is seen in assaults, particularly to the side of the head, or acceleration-deceleration injuries such as car accidents, are the main causes of epidural hematoma.

Other causes include:

  • Infectious diseases of the skull
  • Vascular malformation of the dura mater
  • Malignancies
  • Platelet or coagulation disorders
  • Paget’s disease
  • Hypertension
  • Valsalva maneuver
  • Traumatic childbirth/forceps delivery

Spinal epidural hemorrhage causes include:

  • Lumbar puncture
  • Epidural anesthesia
  • Spine surgery
  • Disk herniation
  • Paget’s disease
  • Hypertension

Risk Factors

Risk factors associated with an increased chance of developing this condition include:

  • Age (elderly patients who have trouble walking)
  • Trauma
  • Alcoholism (increases the risk of falls)
  • People with clotting disorders or those taking anti-coagulation medication

Symptoms

  • Dizziness
  • Headache
  • Confusion
  • Pupil Dilation
  • Blurred vision
  • Vomiting
  • Loss of short-term memory
  • Slurred speech
  • Difficulty walking or moving the arms
  • Weakness in one side or area of the body
  • Sweating
  • Pallor
  • Irritability
  • Drainage from the ears or nose
  • Loss of consciousness
  • Seizure
  • Coma

Symptoms of spinal epidural hemorrhage include:

  • Localized back pain
  • Weakness or numbness
  • Incontinence

Diagnosis

When a physician suspects that a patient might have an epidural hematoma, the first step is a neurological assessment. A physical exam and tests to gauge motor function are performed. Further diagnostic tests may include:

  • CT Scan
  • MRI
  • X-Ray
  • EEG
  • Blood tests

Treatment

  • Medications: anti inflammatory medications and drugs that reduce intracranial pressure can be used during the acute stages. After removal of the clot, the physician might prescribe anti-seizure medications for up to 24 months.
  • Aspiration: very small epidural hematomas that cause no pressure or damage to the surrounding tissue can be treated without surgery. A surgeon will create a small burr hole in the skull and remove the clot with suction.
  • Surgery: the bleed is exposed by open craniotomy. The blood clot is aspirated and the bleeding is stopped by suturing the vessels.

Prevention

  • Wear a helmet during certain sporting activities, including biking, skiing, horseback riding, and snowboarding
  • Wear a seat belt
  • Drink alcohol only in moderate amounts
  • Have a physician supervise doses of anticoagulant medication
  • Use safety equipment at work when indicated (hardhat)

Disclaimer

Content generated and provided by Joshua B. Bederson, MD, Professor and Chairman of the Department of Neurosurgery at The Mount Sinai Health System. Some of the information contained in this article was adapted from the National Institutes of Health. Last reviewed June 2011 by the Department of Neurosurgery at The Mount Sinai Health System.

If you want to learn more about treating epidural hematoma, call the Mount Sinai Department of Neurosurgery at 212-241-2377.