Introduction:
Head injuries should never be carelessly ignored. There are three membrane layers or meninges (coverings) in the brain that are sandwiched between the bony skull and the brain tissues. The function of the meninges is to ensheath and protect the brain and the spinal cord. The dura mater is the outermost covering. In the case of epidural hematoma, there can be a tear in the blood vessel, which is usually an artery but can also be due to a vein. This results in blood leakage into the dura mater, which can exert pressure on the brain.
Is Epidural Hematoma a Serious Condition?
Epidural hematoma is a serious and life-threatening condition requiring immediate medical attention. If not treated at the right time, it can lead to brain damage and death. An epidural hematoma can cause death in nearly 15 % of the cases and is common in 10 % of individuals with head injuries. 75 % of epidural hematomas occur in the temporal region of the brain (the area of the head over the ear).
What Are the Causes of Epidural Hematoma?
A skull fracture that involves the tearing of the middle meningeal artery is the most common reason for bleeding. Severe head injuries due to bicycle, motorcycle, skateboard, automobile, or snowboard accidents, fall from a ladder, and a violent attack or physical abuse are the most common causes of epidural hematoma. Even non-traumatic factors could also cause an epidural hematoma. These include:
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Inefficient clotting of blood (coagulopathy).
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Tumors that cause bleeding (hemorrhagic tumors).
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Presence of abscess or infection.
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Vascular malformations like cavernous malformations and arteriovenous malformations.
What Are the Signs and Symptoms of Epidural Hematoma?
The signs and symptoms are dependent on the severity of the epidural hematoma. The onset of symptoms could be within minutes or hours after one contracts a head injury. The following are the signs and symptoms of epidural hematoma:
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Dizziness and confusion.
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Severe headache.
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Nausea and vomiting.
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Changing levels of alertness or drowsiness.
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Loss of vision in one of the eyes.
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Enlarged pupil on one side.
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Weakness in one part of the body.
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Shortness of breath or other changes may be noticed in the breathing patterns.
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Seizures (sudden, uncontrolled electrical activity in the brain).
If it is not treated, the pressure in the brain can get elevated, and the symptoms can worsen. This can result in loss of brain function, coma, and death.
Who Is More Prone to Suffer From an Epidural Hematoma?
The following are more susceptible:
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Elderly people.
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Previous history of trauma.
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Those taking blood thinning medications.
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Those with drinking habits (consumption of alcohol can increase the risk of falls and other accidents).
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Athletes involved in contact sports or sports which involve fall risks, like gymnastics.
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Those who fail to wear helmets and seatbelts while driving.
How Can Epidural Hematoma Be Diagnosed?
An epidural hematoma can be diagnosed in the following ways:
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Computed tomography (CT) scans or magnetic resonance imaging (MRI) to evaluate the skull and the soft tissues of the brain. In these scans, the hematoma in the head looks like a dense mass that pushes the brain away from the skull.
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Electroencephalogram (EEG) to assess the electrical activity of the brain.
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Neurological tests.
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An angiogram may be suggested to identify non-traumatic causes like arteriovenous malformations.
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Blood tests can be taken to check for factors that can increase the risk of bleeding and also check for conditions that can affect the normal clotting mechanism.
What Are the Treatment Options for Treating Epidural Hematoma?
Treatment is determined by the severity of the injury, the presence of other illnesses or injuries, and the overall health of the individual. Various treatment options include:
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Surgery:
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In mild cases where the epidural hematoma is small or less severe, physicians prefer aspiration to get rid of the hematoma. In aspiration, a small hole is drilled in the skull, followed by suctioning to remove the hematoma. Aspiration helps relieve the pressure in the brain due to the buildup of blood, and the drain may be retained for several days after the surgery to promote the draining of blood.
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A craniotomy is preferred in severe cases. This procedure involves the temporary removal of a part of the skull to remove the hematoma, arrest bleeding from obvious sites, and replace the skull bone in place with the help of tiny screws.
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Medications:
Medications will be prescribed before and after the surgery. Before surgery, hyperosmotic agents like Glycerol, Mannitol, and hypertonic Saline may be prescribed to reduce swelling and inflammation in the brain. Following surgery, anti-seizure medications may be prescribed by the physician to be taken for several months or years after the injury. Pain medications or anti-inflammatory medications may also be prescribed to provide relief to the patient.
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Home-Based Recovery:
After the necessary treatment, one can follow certain steps to accelerate the recovery process. These include taking plenty of rest, refraining from contact sports in the future, gradually increasing activities, and reducing or quitting alcohol consumption. A physician or a therapist might suggest certain exercises to boost the patient’s strength and reduce the sense of weakness.
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Rehabilitative Therapy:
Rehabilitative therapy may include a combination of physical, occupational, and speech therapy. The aim of rehabilitative treatment is to improve strength, regain lost speech skills, retrieve bladder control, improve gross motor functions like walking, recover from paralysis, and restore sensation.
What Are the Complications Following Surgery for Epidural Hematoma?
The complications are as follows:
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Infections can occur at the incision site or deep within the brain, like osteomyelitis (inflammation of the bone due to infection) or meningitis (inflammation of the membrane of the brain and the spinal cord).
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Bleeding can occur either superficially or in deeper layers which can again form a hematoma and might require removal of the hematoma.
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Elevated pressure can squeeze and push the brain tissues such that it is displaced from its normal position. This is called brain herniation and can result in death.
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Seizures can occur even after the hematoma has been managed and treated.
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Damage to the brain or spinal cord can occur, which is characterized by weakness, paralysis, or numbness.
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Coma or death.
Can Epidural Hematoma Be Prevented?
Though epidural hematoma cannot be entirely prevented, certain measures taken at the individual level can prevent the risk of developing epidural hematoma. These measures include:
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Wearing a protective helmet while driving a motorcycle, bicycle, skateboarding, or snowboarding.
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One must always wear a seatbelt while driving a car.
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One must not dive into water that is not entirely free of rocks.
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Appropriate headgear must be worn when engaging in contact sports or high-impact activities.
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Safety gear must be worn by individuals engaged in off-the-ground jobs or jobs associated with a high risk of head injury.
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The home, yard, and workplace should be checked and repaired regularly to reduce the risk of falls and decrease tripping hazards.
Conclusion:
An epidural hematoma is a life-threatening condition that occurs as a result of a head injury. The condition should be addressed at the earliest. If not, it can lead to brain damage, coma, and death. The outcome or prognosis of epidural hematoma is determined by the age of the individual, the time lapse between the injury and initiation of treatment, level of consciousness following injury and upon arrival to the hospital, eye response or movement, and physical and verbal response. Head injuries should never be taken lightly, and one must consult a physician if they experience any of the symptoms mentioned above. Since prevention is better than cure, one must wear protective helmets, headgear, and seatbelts while driving or if engaged in other activities.
