Fact-sheet: Extradural - epidural - hematoma of brain
Updated on 07/01/2020 at 9:37 AM
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Definition
Epidural hematoma is found in fewer than 4% of head injuries.
In adults, they are associated with a skull vault fracture in 90% of cases, and are secondary to arterial injury in 90% of cases.
It is defined by the presence of a blood collection between the skull vault and the dura mater.
Temporoparietal location due to a tear of the middle meningeal artery is the most common.
Temporal fossa or posterior fossa locations are rarer and are often due to venous sinus tears.
Clinical features
History: reveals a history of moderate head trauma resulting in brief loss of consciousness.
Inspection: examination of the impact site sometimes reveals a wound, retroauricular ecchymosis, a Hematoma, tenderness to pressure, as well as findings related to skull base trauma such as periorbital ecchymosis (raccoon eyes), rhinorrhea, epistaxis, otorrhea, otorrhagia, or even hemotympanum (visible on otoscopy).
Clinical examination:
- Assessment for signs of increased intracranial pressure: headache, projectile vomiting.
- Glasgow Coma Scale assessment (prognostic value): within 24 hours, impaired consciousness may occur, potentially progressing to coma.
- Neurologic assessment (motor function, sensation, cranial nerves) looking for focal signs: contralateral motor deficit relative to the point of impact, delayed ipsilateral mydriasis.
Radiography
Not indicated
CT
Non-contrast Computed Tomography of the brain confirms the diagnosis and looks for:
- Spontaneous biconvex lens-shaped hyperdensity whose extension is limited by the sutures and which is often associated with an underlying skull fracture. It defines the characteristics of the Hematoma: location, extent
- Variable mass effect, assessed by displacement of the ventricles and midline shift. Signs of temporal or subfalcine herniation reflect its severity.
- Associated lesions: fractures, associated bleeding.
MRI
Not well suited
May be useful in an infant or when looking for associated lesions (Diffuse axonal injury or evaluation of the posterior fossa)
Management
Medical-surgical emergency.
Depending on the clinical examination:
- monitoring of consciousness and neurological examination
- medical management (analgesia, treatment of intracranial hypertension)
- surgical: burr hole or craniectomy with a bone flap centered on the fracture line, with evacuation of the Hematoma followed by arterial hemostasis, drainage, and closure.