Epidural Hematoma

Diagnosis 

The diagnosis of an epidural hematoma (EDH) typically involves several diagnostic steps: 

• Imaging Techniques: In cases where an EDH is suspected in the head, it appears as a dense mass that applies pressure on the brain, causing it to displace within the skull. To visualize and confirm this condition, medical professionals commonly employ two imaging methods: 
  • Computed Tomography (CT): This technology uses X–rays to create detailed cross–sectional images of the affected area. 
  • Magnetic resonance imaging (MRI) scans: MRI provides highly detailed images using magnetic fields and radio waves. 
  • Angiogram: In situations where a non–traumatic cause, such as an arteriovenous malformation, is suspected as the underlying factor for the EDH, a diagnostic angiogram may be recommended. This procedure involves injecting a contrast dye into the blood vessels and capturing X–ray images to examine the vascular system. 
• Blood test: A blood sample may be collected for laboratory analysis. This serves a dual purpose: 
  • Identifying any factors that could increase the individual’s risk of bleeding. 
  • Evaluating potential underlying medical conditions that may interfere with the normal clotting function of the blood. 

Treatment  

EDH is typically a medical emergency that needs to be treated right away. You may require surgery if you have brain malfunction, a severe headache, or a hematoma with a maximum thickness greater than a pea.  

Without surgery to release the pressure on your brain, you risk dying or suffering a permanent brain injury.  

Surgery 

The preferred surgical approach involves two main procedures: 

• Craniotomy with hematoma evacuation: In this procedure, a portion of the skull is temporarily removed to access and remove the blood clot. Any sources of bleeding are also addressed. Afterward, the skull bone is repositioned and secured with small screws. 
• Skull holes for blood drainage: Alternatively, one or more openings can be made in the skull to allow the blood to drain. This helps reduce the pressure on the brain caused by the accumulated blood. Sometimes, a drain may be left in place for a few days to facilitate continuous blood drainage. 

For individuals with a spinal epidural hematoma: 

• Laminectomy: A small section of bone is removed to relieve pressure on the spinal cord and nerve roots caused by the blood clot. 

Other treatments  

Surgical intervention may not be required for minor brain bleeds that do not cause pressure on the brain and only lead to mild symptoms. The body has the ability to naturally absorb a small amount of blood over several months. When managing a minor brain bleed, regular monitoring with repeat head CT scans will be conducted to ensure the gradual resolution of the hematoma.

Medications  

After surgery, your neurologist or neurosurgeon might recommend medications to alleviate inflammation and reduce intracranial pressure. These prescribed drugs could include mannitol, hypertonic saline, and glycerol. Additionally, in certain cases, an antiseizure medication may be prescribed temporarily, as seizures can occasionally arise as a complication of head injuries.

Rehabilitation therapy  

Your neurologist will prescribe the appropriate therapy, such as physical therapy, occupational therapy, and/or speech therapy, if you have suffered brain injury.