Epidural Hemorrhage

Bleeding between the skull and membranes covering the brain is called an epidural hemorrhage. This is caused by injury to an artery along the skull, often due to a direct hit (blunt trauma). This condition may be confused with inflammation of the brain lining (meningitis). Epidural hemorrhage often leads to a collection of clotted blood (hematoma) that grows quickly. This increases pressure in the skull, causing symptoms and sometimes death.

SYMPTOMS

These symptoms develop within 1 to 96 hours after a head injury:

  • Headache that steadily gets worse. Drowsiness or unconsciousness. Nausea or vomiting.

  • Inability to move arms or legs.

  • Changes in the pupils: unequal in size, not responsive to light.

CAUSES

A cut (laceration) of an artery (middle meningeal artery) along the skull. Often, related to skull fracture.

RISK INCREASES WITH:

  • Use of blood thinners (anticoagulant drugs), including aspirin or warfarin, and anti-inflammatory medicines.

  • Bleeding disorders (hemophilia, aplastic anemia).

  • Sports where head injury is likely (boxing, football, rugby, hockey, auto racing, motorcycle riding, bicycle racing (road and mountain), horseback riding).

PREVENTION

  • Avoid head injury.

  • Wear properly fitted and padded protective headgear.

PROGNOSIS

Recovery depends on many factors. These include: general health, age, extent of the injury, speed of treatment, and extent of the bleeding or clot. After the clot is removed, brain tissue that has been under pressure often expands to fill its original space. Quick diagnosis and prompt surgery can often result in complete recovery.

RELATED COMPLICATIONS

  • Death, if pressure on the brain and bleeding last over 24 hours.

  • Permanent brain damage. This can include partial or complete paralysis, behavior and personality changes, and speech problems.

  • Convulsions.

TREATMENT

This is a medical emergency. It must be treated immediately. Treatment consists of surgery, where a hole is drilled in the skull to drain the blood clot and relieve pressure on the brain. The damaged artery is repaired. If speech or muscle control has been damaged, physical, occupational, or speech therapy may be needed. Once you have this condition, do not play contact sports.

MEDICATION

  • Steroid medicines and diuretics may be used. This reduces swelling inside the skull.

  • Anti-convulsant medicine may be prescribed. This is to prevent seizures.

SEEK MEDICAL CARE IF:

  • You develop any symptoms of epidural hematoma or hemorrhage. This is an emergency!

  • Any of the following occur during treatment:

  • Fever develops.

  • Surgery wound becomes red, swollen, or tender.

  • Headache gets worse.

  • Drowsiness increases. Unconsciousness develops.

  • Nausea or vomiting begin.

  • Confusion increases. Mental changes develop.

  • Seek medical advice for even a moderate blow to the head.