Epidural Hematomas

Epidural Hematomas
An epidural hematoma can be arterial or venous in origin. When arterial, it is usually involving the middle meningeal artery which can rupture after a blunt or penetrating trauma to the temporal region of the skull. Venous epidural hematomas are more common in pediatrics.
These bleeds represent 2% of all head injury patients and 5-15% of fatal head injuries. About 85-90% of epidural hematomas have an associated skull fracture. The hematoma is basically dissecting or spreading the thin layer of “potential space” between the dura that overlies the brain and the skull.
The classic presentation of a patient is someone who sustains a focal trauma to the head (ie. From a hammer, baseball bat, fall, MVC) and has a loss of consciousness followed by waking up and feeling well to eventual neurologic deterioration. Although classically associated with epidural hematomas, this presentation only occurs in about 20% of patients with epidural bleeds. Other symptoms include severe headache, nausea, vomiting, lethargy, and seizure.
All patients with head injuries concerning for brain bleeds will have an CT evaluation for determine the type and size of bleed. After this, based on the neuro exam a decision is made to either go to surgery to evacuate the blood and find the bleeder or watch and wait to see how the patient progresses. If the patient has any coagulopathy or is on a blood-thinner, this is typically correct to help stop the bleed. Smaller epidural hematomas will likely resolve on their own without an intervention.
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