An epidural haematoma, sometimes called an extradural haematoma, is a build-up of blood that forms between the inner surface of the skull and the outer layer of the hard   brain sheath   (dura mater). They are often epidural haematomas associated with the history of trauma and associated skull fracture, and are typically seen in younger people who have suffered head trauma. About 15-20% of epidural hematoma are fatal.

Unlike subdural hematoma, where it is difficult to detect head trauma cleanly, extradural haemorrhages are usually perceived with a purely defined head trauma.

Clinical picture

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A typical presentation is that of a younger patient with a blow to the head (often during sports activities or as a result of motorcycle accidents), who suffered (not necessarily) a transient loss of consciousness. In a third of patients, the clinical picture is characterized by sudden loss of consciousness at the time of trauma. After injury, they regain a normal interval of consciousness (lucid interval)that usually lasts about half an hour, but usually has a constant and often severe headache. Over the next few hours, the consciousness disorder gradually develops again due to an increase in hematoma that causes the brain stem to compression by uncalable herniation. A characteristic symptom is ipsilateral anizrisocorium and areflection (Hutchinson’s pupil), with a deepening of the coma ending in death if no urgent neurosurgical intervention is undertaken.

If there is bleeding in the rear cranial pit, it is characterized by the development of consciousness disorders, the braking of the sewing and cerebellar symptoms. the shift of brain tissue in the caudo-cranial direction causes damage to the brain stem or herniation through the foramen magnum, and this causes rapid death. Herniation here is tonsillitis and causes Cushing’s triass: hypertension, bradycardia and irregular breathing.

Pathophysiology

epidural haematoma

The source of the bleeding is a typically torn meningeal artery– usually the middle meningeal artery (a.meningea media). In 75% of cases, skull fractures are present. Pain in the form of a severe headache is caused by peeling the pout off the bone during the spread of the hematoma. The rear skull pit is a rare site of injury in general, including subdural hematoma. Occasionally the epidural haematoma can be the result of venous bleeding, typical of venous sinus injury due to a related fracture.

The fact that younger patients are more likely to be affected by this injury is not only the result of the demographics of patients with head injuries, but also with changes that occur to the hard brain sheath in elderly patients – in them the dura is much more attached to the skull.

Epidural haematomas are unilateral in more than 95% of cases. 95% of them are also housed supratorially. Temporopariethyl is 60% (pterion, which lies over the middle meningeal artery, is relatively weak and prone to injury), frontal 20%, paryocipital 20%. Less than 5% of the epidural haematoma is located infratentoralally in the posterior cranial pit (and this is due to bleeding from sinus injury).

Since epidural haematomas are located between the skull and the parietal layer of the hard brain sheath, which is actually the periphery of the bone, the expansion of the epidural hematoma is usually limited by the seams of the skull, as the perimeter passes through the seam connected to the outer periostal layer. This helps to distinguish the epidural from the subdural hematoma – the subdural hematoma is not limited by the seams.

But epidural haematomas can pass venous sinuses and lift them if there are no seams present – venous sinuses are placed between the parietal and visceral layers of the pout. 

Exceptions, of course, exist. For example, if the skull fracture itself passes over the seam or if the seams are abnormally dilated (e.g. as physiologically in newborns).

Diagnosing

ct haematoma

Treatment

As with other types of intracranial hematoma, blood can be removed surgically and thus reduce pressure on the brain. The haematoma is removed by blinking or craniotomy.

Forecast

The prognosis is good even with a relatively large hematoma, if the hematoma is removed quickly. A small hematoma with no mass effect or a ”     swirl” sign can be treated conservatively, which sometimes results in the calcification of the pout. Sometimes they encounter dedrating complications, usually associated with meningeal blood vessel injury, such as pseudoaneursize and AV fistula. The prognosis is generally better if there was a lucid interval. 

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