What is Epidural Hematoma?
Epidural hematoma is the presence of blood that collects in the epidural area, the area between the skull bones and the layer of duramater. Duramater is the membrane or outermost layer of mening (the lining of the brain and spine) that envelop and protect the brain and spine. In the head, the dura layer is usually attached to the inner skull so it is prone to bleeding.
Epidural hematoma can occur in the head and spine, but usually occurs in the head due to injuries that cause skull fractures. These conditions, especially those that occur in the arteries in the brain, are serious and require emergency treatment to remove collected blood before causing further injury.
Causes of Epidural Hematoma
Epidural hematoma is caused by several factors, depending on the area experiencing this condition. Epidurals occurring in the spine are called epidural hematoma of the spine and are less common than epidural hematomas that occur in the head. Epidural hematoma that occurs in the head is called intracranial extradural haematoma because it is one type of other bleeding that also occurs in the head (intracranial hematoma). The causes of epidural hematoma by its location, namely:
- Epidural hematoma head
This condition is most commonly caused by a head injury that causes cracks in the skull, such as traffic accidents on the highway. Other causes, namely a fall or a very hard or intense blow, physical contact when exercising. This crack then makes the dura layer free from the skull and damage the main blood vessels until there is bleeding in the epidural area.
A person who experiences a hard or sudden collision can also make the brain shift or tangent to the inside of the skull until there is a bruise or a tear. Collisions can tear out layers, tissues, or blood vessels. Furthermore, there was bleeding in the epidural area.
Blood resulting from this collision then collects and forms a hematoma which then creates pressure on the brain tissue. The brain will then start short of blood intake and symptoms begin to appear. If not treated immediately, excessive pressure on the brain can trigger brain damage. Most cases of epidural hematoma is a dangerous situation because it can occur immediately after an accident is experienced.
- Epidural hematoma of the spine
This condition usually occurs due to injury around the spine. The injury may be caused by a spinal fluid retention procedure while attempting to diagnose a disease or an epidural anesthetic procedure for labor. Injuries can also occur in someone taking anticoagulant drugs (blood thinners) as part of their treatment, but this condition is also less common.
However, spinal epidural hematoma injuries are usually rare. Therefore, this article will further discuss the type of epidural hematoma that occurs in the head.
Epidural hematoma most commonly experienced by people aged 11-16 years, men, and people who have a habit of consuming alcoholic beverages in excess. The risk will be less experienced by those aged over 60 years because it has a layer of dura that has been firmly attached to the skull so that the dura is not easily separated and bleeding.
Symptoms of Epidural Hematoma
Both the epidural hematoma of the head and spine have symptoms that can be directly felt or newly felt several days after the injury is experienced. Slower hemorrhage becomes the cause of indirect symptoms known after the injury occurs. Some symptoms of epidural hematoma, namely:
- Loss of consciousness when injury is experienced, then regained consciousness for several hours before it gradually worsens and regains consciousness as a sign of blood has accumulated in the epidural area. Not everyone has this condition.
- Not immediately fainted after an injury, but experiencing a sense of drowsiness or severe headaches. Patients who lose consciousness can also experience this after they regain consciousness.
- Nausea or vomiting.
- Dazed or confused.
- Do not have power / weakness on the hands or legs on one side of the body.
- Having difficulty speaking.
- Looks normal and speaks fluently, but then in the next minute feel sick and lost consciousness.
- Pupil enlarged in one eye. Generally on the reverse side with the side of the body experiencing weakness.
- Bruises around the eyes.
- The release of clear liquid from the nose or ears.
- Bruises behind the ear.
- Shortness of breath or have a changing pattern of breath.
Diagnosis of Epidural Hematoma
A person who has an injury, then loses consciousness or has severe headaches, or as the symptoms above, should be immediately taken to the hospital for medical treatment. In general, epidural hematoma requires immediate emergency treatment.
The doctor will perform a thorough examination to look for signs of epidural hematoma, injury or other type of intracranial hematoma. Some possible checks are:
- Check the level of consciousness.
- Examine the eye condition as a sign of increased pressure inside the skull.
- Test the level of strength on the hands and feet.
- Blood tests to detect abnormal blood clots or abnormal blood viscosity.
- CT scan to see if there is a fracture of the skull or other intracranial hematoma.
- X-ray to see any injuries at different body locations
Epidural Hematoma Treatment
The first treatment performed for people with epidural hematoma is to stabilize the patient’s condition. Return of blood pressure and level of consciousness to normal level are some things that are usually done in patients. Small blood clots and no symptoms will break down by itself. You can go through a series of physical examinations and CT scans repeatedly to monitor the size of the blood clot and the symptoms of epidural hematoma. The ventilator device may be installed if the patient has difficulty breathing. Your condition will continue to be monitored to anticipate the hematoma grows and the worsening of symptoms.
If the doctor finds an increase in pressure on the head, then medication can be given or followed by surgical procedures. An enlarged or worsening hematoma should be removed, usually by a craniotomy procedure. The craniotomy procedure is performed by making a Burr hole in the skull bone. The patient’s condition is then continuously monitored in the postoperative intensive care unit.
A craniotomy is a procedure in which a small portion of the skull is removed to reduce the pressure inside the brain and remove the blood clot present in the epidural. The skull is then returned to its original position, attached to the dura layer, then closed.
Epidural hematoma is treated immediately can reduce permanent brain damage although there is still the possibility of it to happen, such as difficulty speaking, seizures, or weakness on one side of the body. However, this condition may improve with a series of physical or pharmaceutical therapies.
The success rate of epidural hematoma treatment will also increase and tend to be good if the patient does not lose consciousness before surgery and vice versa. The prognosis of surgery will be worse in patients who have lost consciousness prior to the surgical procedure.
Epidural Hematoma Prevention
Using head and body protection tools is a precautionary measure that can be taken to reduce the risk of epidural hematoma or serious injury while undergoing high-risk sports activities causing head injury.
Some sports can cause a person to have a brain injury from an accident that affects the head, such as cycling, skateboarding, skiing, roller blade, or boxing.
Also wear safety belts while driving in a car or other type of vehicle, especially for children. Start to limit the area or organize objects and furniture so as not to harm the children (childproofing), for example, installing a safety on the tip of the closet or stairs.
As mentioned earlier, a person who has a habit of consuming alcohol is also excessive risk of epidural hematoma because it is more vulnerable to fall or bump. Avoid excessive alcohol consumption. Not only help you reduce the risk of epidural hematoma, but also the development of other diseases, such as heart disease and liver cirrhosis.