Epidural Hematoma

Aka: Epidural Hematoma, Epidural Hemorrhage

II. Pathophysiology

  1. Middle Meningeal Artery rupture
    1. middleMeningealArtery.jpg
  2. Results in blood accumulation between skull and dura
  3. Associated with a temporal bone Skull Fracture in most cases

III. Symptoms

  1. Headache
  2. Vomiting

IV. Signs: Pathognomonic Presentation

  1. Loss of consciousness
  2. Period of lucency interspersed between 2 distinct periods of LOC
    1. Variably present and variable timing
    2. Absent in most cases, in which patient remains comatose without period of lucidity
  3. Loss of consciousness

V. Signs: Transtentorial bleed findings

  1. Contralateral Hemiparesis
  2. Ipsilateral fixed and dilated pupil (Cranial Nerve III palsy) in 85% of cases
    1. Heralds impending Cerebral Herniation

VI. Imaging: CT Head

  1. Focal bleeding in territory of middle meningeal artery (contrast with subdural which can extend fully anterior to posterior)
  2. Convex "lens" appearance on CT (contrast with concave crescent in Subdural Hematoma)
    1. Outside the dura, and therefore follows the inner skull surface
    2. Blood dissects between the skull and the tightly adherent dura

VII. Precautions

  1. Epidural Hemorrhage may be rapidly fatal

VIII. Evaluation

  1. See Trauma Evaluation
  2. See Head Injury

IX. Management

  1. See ABC Management
  2. See Management of Severe Head Injury
  3. See Increased Intracranial Pressure in Closed Head Injury
  4. Rapid assessment and management is key
  5. Emergent Neurosurgical Consultation
  6. Emergent decompression in the Emergency Department
    1. Indicated in imminent Cerebral Herniation (Ipsilateral fixed and dilated pupil) and delay to neurosurgery
    2. See Skull Trephination
  7. Neurosurgical decompression indications
    1. Epidural Hematoma width >15 mm
    2. Epidural Hematoma volume >30 ml
    3. Midline shift >5 mm
    4. Poor mental status (GCS <8)
    5. Bullock (2006) Neurosurgery 58(3 suppl): S7-15 [PubMed]

X. References

  1. Dreis (2020) Crit Dec Emerg Med 34(7):3-21

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Related Studies

Ontology: Hematoma, Epidural, Cranial (C0238154)

Definition (SNOMEDCT_US) Bleeding into the intracranial extradural space
Definition (SCTSPA) Sangrado en el espacio extradural intracraneal.
Definition (NCI_FDA) Intracranial hemorrhage into the epidural space.
Definition (NCI) Intracranial hemorrhage into the epidural space.
Definition (MSH) Accumulation of blood in the EPIDURAL SPACE between the SKULL and the DURA MATER, often as a result of bleeding from the MENINGEAL ARTERIES associated with a temporal or parietal bone fracture. Epidural hematoma tends to expand rapidly, compressing the dura and underlying brain. Clinical features may include HEADACHE; VOMITING; HEMIPARESIS; and impaired mental function.
Concepts Injury or Poisoning (T037)
MSH D006407
ICD10 S06.4 , S06.4X, S06.4X9
SnomedCT 82999001, 428268007, 209985004, 155392004, 230742006
English Epidural hematoma, EPIDURAL HEMATOMA, Epidural haematoma, Extradural Hemorrhage, Extradural hemorrhage NOS, Hematoma, Epidural, Cranial [Disease/Finding], extradural hemorrhage, epidural hematomas, hematoma epidural, Haemorrhage;epidural, Haemorrhage;epidural;traumatic, epidural haematoma, epidural hematoma, hemorrhage epidural, extradural haematoma, extradural hematoma, Epidural hemorrhage NOS, Extradural haematoma, Extradural hematoma, Intracranial epidural haematoma, Intracranial epidural hematoma, Epidural Hemorrhage, Epidural hematoma (disorder), Epidural intracranial hemorrhage, Epidural intracranial hematoma, Epidural intracranial hemorrhage (disorder), Epidural intracranial haemorrhage, Epidural intracranial hematoma (disorder), Epidural intracranial haematoma, Epidural hemorrhage (disorder), Extradural haematoma (disorder), EXTRADURAL HEMORRHAGE, HEMORRHAGE, EXTRADURAL, Extradural intracranial haematoma, Extradural intracranial hematoma, Epidural hemorrhage, Epidural haemorrhage, Extradural haemorrhage, Extradural hemorrhage, EDH - Extradural haematoma, EDH - Extradural hematoma, epidural; hematoma, extradural; hemorrhage, hematoma; epidural, hemorrhage; extradural, Epidural hemorrhage, NOS, Extradural hemorrhage, NOS, Epidural hemorrhage [dup] (disorder), Cranial Epidural Hematomas, Cranial Epidural Hematoma, Cranial Epidural Hemorrhages, Cranial Epidural Hemorrhage, Cranial Extradural Hematomas, Cranial Extradural Hematoma, Cranial Extradural Hemorrhages, Cranial Extradural Hemorrhage, Epidural Hematoma, Cranial, Epidural Hematoma, Intracranial, Epidural Hematomas, Cranial, Epidural Hematomas, Intracranial, Epidural Hemorrhage, Cranial, Epidural Hemorrhages, Cranial, Extradural Hematoma, Cranial, Extradural Hematomas, Cranial, Extradural Hemorrhage, Cranial, Extradural Hemorrhages, Cranial, Hematoma, Cranial Epidural, Hematoma, Cranial Extradural, Hematoma, Epidural, Cranial, Hematoma, Epidural, Intracranial, Hematoma, Intracranial Epidural, Hematomas, Cranial Epidural, Hematomas, Cranial Extradural, Hematomas, Intracranial Epidural, Hemorrhage, Cranial Epidural, Hemorrhage, Cranial Extradural, Hemorrhages, Cranial Epidural, Hemorrhages, Cranial Extradural, Intracranial Epidural Hematomas, Intracranial Epidural Hematoma, Hemorrhage;epidural, Hemorrhage;epidural;traumatic, epidural haemorrhage, epidural hemorrhage, traumatic epidural hemorrhage, traumatic epidural haemorrhage
Italian Ematoma extradurale, Ematoma epidurale, Ematoma extradurale cranico, Emorragia epidurale cranica, Emorragia extradurale cranica, Ematoma epidurale intracranico, Emorragia epidurale, Ematoma epidurale cranico
Dutch intracraniaal epiduraal hematoom, epiduraal hematoom, epidurale hemorragie, bloeding; extraduraal, epiduraal; hematoom, extraduraal; bloeding, hematoom; epiduraal, Epidurale bloeding, extraduraal hematoom, Bloeding, craniale epidurale, Craniaal epiduraal hematoom, Hematoom, epiduraal, craniaal
French Hématome épidural, Hématome épidural intracrânien, Hématome extradural, Hémorragie épidurale, Hématome extradural crânien, Hématome extradural du crâne, HED (Hématome ExtraDural), Hématome extra-dural, Hématome extradural intracrânien
German Epiduralhaematom, intrakranielles Epiduralhaematom, interkranielles Epiduralhaematom, Intrakranielles epidurales Hämatom, Epiduralblutung, Epidurale Blutung, extradurales Haematom, Extradurale Blutung, Epidurales Hämatom, Extradurale Hämorrhagie, Hämatom, epidurales
Portuguese Hematoma intracraniano epidural, Hematoma epidural, Hematoma epidural intracraniano, Hemorragia epidural, Hematoma extradural, Hematoma Craniano Epidural, Hemorragia Craniana Epidural, Hematoma Epidural Craniano
Spanish Hematoma intracraneal epidural, Hematoma epidural intracraneal, Hematoma epidural, hematoma epidural, hematoma epidural (trastorno), Hemorragia epidural, hematoma extradural, hemorragia epidural (trastorno), hemorragia epidural, hemorragia extradural, Hematoma extradural, Hematoma Craneal Epidural, Hemorragia Craneal Epidural, Hematoma Epidural Craneal
Japanese 硬膜外血腫, ｺｳﾏｸｶﾞｲｹｯｼｭ, 硬膜外出血-頭蓋, 硬膜上出血-頭蓋, 硬膜外血腫-頭蓋内, 血腫-頭蓋硬膜外, 頭蓋硬膜上血腫, 硬膜外血腫-頭蓋, 頭蓋硬膜外出血, 硬膜上血腫-頭蓋, 頭蓋硬膜上出血, 頭蓋内硬膜外血腫, 血腫-硬膜外-頭蓋, 頭蓋硬膜外血腫, ﾄｳｶﾞｲﾅｲｺｳﾏｸｶﾞｲｹｯｼｭ, ｺｳﾏｸｶﾞｲｼｭｯｹﾂ, 硬膜外出血
Swedish Epiduralblödning, kraniell
Czech hematom epidurální kraniální, hemoragie kraniální epidurální, kraniální epidurální hematom, Intrakraniální epidurální hematom, Epidurální hematom, Extradurální hematom, Epidurální krvácení
Finnish Epiduraalihematooma
Russian EKSTRADURAL'NAIA GEMORRAGIIA, GEMATOMA EPIDURAL'NAIA, GEMATOMA EPIDURAL'NAIA CHEREPNAIA, GEMATOMA EPIDURAL'NAIA KRANIAL'NAIA, ГЕМАТОМА ЭПИДУРАЛЬНАЯ, ЭКСТРАДУРАЛЬНАЯ ГЕМОРРАГИЯ, ГЕМАТОМА ЭПИДУРАЛЬНАЯ КРАНИАЛЬНАЯ, ГЕМАТОМА ЭПИДУРАЛЬНАЯ ЧЕРЕПНАЯ
Korean 경막위 출혈
Polish Krwiak nadtwardówkowy czaszki, Krwiak nadoponowy czaszki
Hungarian Extraduralis haematoma, Epiduralis haematoma, Intracranialis epiduralis haematoma, Epiduralis vérzés, Epiduralis haemorrhagia
Norwegian Kranial epiduralblødning, Kranialt epiduralhematom, Hematom, epiduralt kranialt
Derived from the NIH UMLS (Unified Medical Language System)

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