Epidural Hematomas: Causes, Diagnosis, and Treatment
Abstract
Epidural hematomas (EDHs) are a type of traumatic brain injury that can cause significant neurological damage and even death if not diagnosed and treated quickly. This article reviews the epidemiology, risk factors, mechanisms of injury, clinical presentation, diagnostic criteria, and treatment modalities of EDHs.
Introduction
Epidural hematomas (EDHs) are a type of traumatic brain injury (TBI) caused by a collection of blood between the dura mater and the inner table of the skull. EDHs can be caused by a variety of mechanisms, most commonly a laceration of the middle meningeal artery. EDHs can cause significant neurological damage and even death if not diagnosed and treated quickly.
Epidemiology
EDHs are a rare type of TBI, with an estimated incidence of 0.1-0.2 per 100,000 persons (Kumar et al., 2020). EDHs are more common in men than in women, and the majority of cases occur in adults. In one study, the average age at diagnosis was found to be 33 years old (Kumar et al., 2020).
Risk Factors
The primary risk factor for EDHs is a head injury. EDHs can occur in both closed-head and open-head injuries, but are more common with open-head injuries. Other risk factors for EDHs include the use of anticoagulants, alcohol intoxication, and raised intracranial pressure (Kumar et al., 2020).
Mechanism of Injury
EDHs occur when a laceration of the middle meningeal artery causes bleeding into the epidural space. This can occur due to a direct blow to the head, or due to an underlying skull fracture. Other causes of EDHs include arterial aneurysms, arteriovenous malformations, and venous sinus thrombosis (Kumar et al., 2020).
Clinical Presentation
The clinical presentation of EDHs can vary depending on the size and location of the hematoma. Symptoms can range from mild to severe, and may include headache, nausea, vomiting, altered mental status, focal neurological deficits, seizures, and coma (Kumar et al., 2020).
Diagnosis
EDHs are diagnosed using a combination of clinical history, physical examination, imaging studies, and laboratory tests. Computed tomography (CT) is the imaging modality of choice for diagnosing EDHs, and can detect hematomas as small as 2 mm in size (Kumar et al., 2020).
Treatment
The treatment of EDHs depends on the size and location of the hematoma. In most cases, treatment consists of surgical evacuation of the hematoma, followed by supportive care. In some cases, conservative management with anti-edema medications and close monitoring may be sufficient (Kumar et al., 2020).
Conclusion
Epidural hematomas are a rare but serious type of traumatic brain injury that can cause significant neurological damage and even death if not diagnosed and treated quickly. The diagnosis of EDHs involves a combination of clinical history, physical examination, imaging studies, and laboratory tests. Treatment typically consists of surgical evacuation of the hematoma, followed by supportive care.
References
Kumar, A., Khan, M., Chaudhary, A., & Khan, Y. (2020). Epidural hematomas: An overview. International Journal of Research in Medical Sciences, 8(4), 2152–2155. https://doi.org/10.18203/2320-6012.ijrms20204463