BACK TOTOP Browse A-ZSearchBrowse A-ZABCDEFGHIJKLMNOPQRSTUVWXYZ0-9 E-mail FormEmail ResultsName:Email address:Recipients Name:Recipients address:Message: Print-FriendlyBookmarksbookmarks-menuEpidural hematomaExtradural hematoma; Extradural hemorrhage; Epidural hemorrhage; EDHAn epidural hematoma (EDH) is bleeding between the inside of the skull and the outer covering of the brain (called the dura). Causes An EDH is often caused by a skull fracture during childhood or adolescence. The membrane covering the brain is not as closely attached to the skull as it is in older people and children younger than 2 years. Therefore, this type of bleeding is more common in young people.FractureIf more pressure is put on a bone than it can stand, it will split or break. A break of any size is called a fracture. If the broken bone punctures...Read Article Now Book Mark Article An EDH can also occur due to rupture of a blood vessel, usually an artery. The blood vessel then bleeds into the space between the dura and the skull.The affected vessels are often torn by skull fractures. The fractures are most often the result of a severe head injury, such as those caused by motorcycle, bicycle, skateboard, snow boarding, or automobile accidents.Rapid bleeding causes a collection of blood (hematoma) that presses on the brain. The pressure inside the head (intracranial pressure, ICP) increases quickly. This pressure may result in more brain injury.Intracranial pressure, ICPIncreased intracranial pressure is a rise in the pressure inside the skull that can result from or cause brain injury.Read Article Now Book Mark Article Symptoms Contact a health care provider for any head injury that results in even a brief loss of consciousness, or if there are any other symptoms after a head injury (even without loss of consciousness).Head injuryA head injury is any trauma to the scalp, skull, or brain. Head injury can be either closed or open (penetrating). A closed head injury means you rec...Read Article Now Book Mark Article Loss of consciousnessDecreased alertness is the most severe state of reduced awareness and is a serious condition. A coma is a state of decreased alertness from which a p...Read Article Now Book Mark Article The typical pattern of symptoms that indicate an EDH is a loss of consciousness, followed by alertness, then loss of consciousness again. But this pattern may NOT appear in all people.The most important symptoms of an EDH are:Confusion ConfusionConfusion is the inability to think as clearly or quickly as you normally do. You may feel disoriented and have difficulty paying attention, remembe...Read Article Now Book Mark Article Dizziness DizzinessDizziness is a term that is often used to describe 2 different symptoms: lightheadedness and vertigo. Lightheadedness is a feeling that you might fai...Read Article Now Book Mark Article Drowsiness or altered level of alertness DrowsinessDrowsiness refers to feeling more sleepy than normal during the day. People who are drowsy may fall asleep in when they do not want to or at times w...Read Article Now Book Mark Article Enlarged pupil in one eye Headache (severe) HeadacheA headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are rare. Most people with headaches can feel much better...Read Article Now Book Mark Article Head injury or trauma followed by loss of consciousness, a period of alertness, then rapid deterioration back to unconsciousness Head injuryA head injury is any trauma to the scalp, skull, or brain. Head injury can be either closed or open (penetrating). A closed head injury means you rec...Read Article Now Book Mark Article Loss of consciousnessDecreased alertness is the most severe state of reduced awareness and is a serious condition. A coma is a state of decreased alertness from which a p...Read Article Now Book Mark Article UnconsciousnessUnconsciousness is when a person is unable to respond to people and activities. Doctors often call this a coma or being in a comatose state. Other c...Read Article Now Book Mark Article Nausea or vomiting Nausea or vomitingNausea is feeling an urge to vomit. It is often called "being sick to your stomach. "Vomiting or throwing-up is forcing the contents of the stomach ...Read Article Now Book Mark Article Weakness in part of the body, usually on the opposite side from the side with the enlarged pupil WeaknessWeakness is reduced strength in one or more muscles.Read Article Now Book Mark Article Seizures can occur as a result of head impactThe symptoms usually occur within minutes to hours after a head injury and indicate an emergency situation.Sometimes, bleeding does not start for hours after a head injury. The symptoms of pressure on the brain also do not occur right away. Exams and Tests The brain and nervous system (neurological) examination may show that a specific part of the brain is not working well (for instance, there may be arm weakness on one side). The exam may also show signs of increased ICP, such as:Headaches Somnolence Confusion Nausea and vomitingIf there is increased ICP, emergency surgery may be needed to relieve the pressure and prevent further brain injury.A non-contrast head CT scan will confirm the diagnosis of EDH, and will pinpoint the exact location of the hematoma and any associated skull fracture. MRI may be useful to identify small epidural hematomas from subdural ones.Head CT scanA head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.Read Article Now Book Mark Article Treatment An EDH is an emergency condition. Treatment goals include:Taking measures to save the person's life Controlling symptoms Minimizing or preventing permanent damage to the brain Life support measures may be required. Emergency surgery is often necessary to reduce pressure within the brain. This may include drilling a small hole in the skull to relieve pressure and allow blood to drain outside the skull.Large hematomas or solid blood clots may need to be removed through a larger opening in the skull (craniotomy).Blood clotsBlood clots are clumps that occur when blood hardens from a liquid to a solid. A blood clot that forms inside one of your veins or arteries is calle...Read Article Now Book Mark Article CraniotomyBrain surgery is an operation to treat problems in the brain and surrounding structures.Read Article Now Book Mark Article Medicines used in addition to surgery will vary according to the type and severity of symptoms and brain damage that occurs.Antiseizure medicines may be used to control or prevent seizures. Some medicines called hyperosmotic agents may be used to reduce brain swelling.For people on blood thinners or with bleeding disorders, treatments to prevent further bleeding might be needed. Outlook (Prognosis) An EDH has a high risk of death without prompt surgical intervention. Even with prompt medical attention, a significant risk of death and disability remains. Possible Complications There is a risk of permanent brain injury, even if EDH is treated. Symptoms (such as seizures) may persist for several months, even after treatment. In time they may become less frequent or disappear. Seizures may begin up to 2 years after the injury.SeizuresA seizure is the physical changes in behavior that occurs during an episode of abnormal electrical activity in the brain. The term "seizure" is often...Read Article Now Book Mark Article In adults, most recovery occurs in the first 6 months. Usually there is some improvement over 2 years.If there is brain damage, full recovery isn't likely. Other complications include permanent symptoms, such as:Herniation of the brain and permanent coma Herniation of the brainBrain herniation is the shifting of the brain tissue from one space in the brain to another through various folds and openings.Read Article Now Book Mark Article Normal pressure hydrocephalus, which can lead to weakness, headaches, incontinence, and difficulty walking Normal pressure hydrocephalusHydrocephalus is a buildup of spinal fluid inside the fluid chambers of the brain. Hydrocephalus means "water on the brain. "Normal pressure hydroce...Read Article Now Book Mark Article Paralysis or loss of sensation (which began at the time of the injury) When to Contact a Medical Professional Go to the emergency room or call 911 or the local emergency number if symptoms of EDH occur.Spinal injuries often occur with head injuries. If you must move the person before help arrives, try to keep his or her neck still.Call the provider if these symptoms persist after treatment:Memory loss or problems focusing Dizziness Headache Anxiety Speech problems Loss of movement in part of the body Go to the emergency room or call 911 or the local emergency number if these symptoms develop after treatment:Trouble breathing Seizures Enlarged pupils of the eyes or the pupils are not same size Decreased responsiveness Loss of consciousness Prevention An EDH may not be preventable once a head injury has occurred.To lessen the risk of head injury, use the right safety equipment (such as hard hats, bicycle or motorcycle helmets, and seat belts).Follow safety precautions at work and in sports and recreation. For example, do not dive into water if the water depth is unknown or if rocks may be present.Open ReferencesReferencesNational Institute of Neurological Disorders and Stroke website. Traumatic brain injury: hope through research. www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Traumatic-Brain-Injury-Hope-Through. Updated April 24, 2020. Accessed November 3, 2020.Shahlaie K, Zwienenberg-Lee M, Muizelaar JP. Clinical pathophysiology of traumatic brain injury. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 346.Wermers JD, Hutchison LH. Trauma. In: Coley BD, ed. Caffey's Pediatric Diagnostic Imaging. 13th ed. Philadelphia, PA: Elsevier; 2019:chap 39.AllVideoImagesTogRelated Information Broken bone(Injury)Decreased alertness(Symptoms)Seizures(Symptoms)Brain herniation(Condition)Normal pressure hydrocephalus(Condition) Review Date: 8/2/2020 Reviewed By: Amit M. Shelat, DO, FACP, FAAN, Attending Neurologist and Assistant Professor of Clinical Neurology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY. Review provided by VeriMed Healthcare Network. 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