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Epidural Hematomas

Epidural hematomas are caused by bleeding from an artery or a large vein


(venous sinus) located between the skull and the outer layer of tissue covering
the brain. Bleeding often occurs when a skull fracture tears the blood vessel.
A severe headache may develop immediately or after several hours. The
headache sometimes disappears but returns several hours later, worse than
before. Deterioration in consciousness, including increasing confusion,
sleepiness, paralysis, collapse, and a deep coma, can quickly follow. Some
people lose consciousness after the injury, regain it, and have a period of
unimpaired mental function (lucid interval) before consciousness deteriorates
again. People may develop paralysis on the side of the body opposite the
hematoma, speech or language impairment, or other symptoms, depending on
which area of the brain is damaged (see Brain Dysfunction by Location).
Early diagnosis is crucial and is usually based on results of CT. Doctors treat
epidural hematomas as soon as they are diagnosed. Prompt treatment is
necessary to prevent permanent damage. Usually, one or more holes are
drilled in the skull to drain the excess blood. The surgeon also seeks the source
of the bleeding and stops the bleeding.

Pockets of Blood in the Brain

A head injury can cause bleeding in the brain. It can result in a pocket of blood between the skull and the
outer layer of tissue covering the brain. This pocket of blood is called an epidural hematoma. Or a pocket of
blood may form between the outer and middle layers of tissue. This pocket of blood is called a subdural
hematoma.

Symptoms and Diagnosis

Symptoms may include a persistent headache, fluctuating drowsiness,


confusion, memory changes, paralysis on the side of the body opposite the
hematoma, and speech or language impairment. Other symptoms may occur
depending on which area of the brain is damaged (see Brain Dysfunction by
Location). In infants, a subdural hematoma can cause the head to enlarge (as
in hydrocephalus) because the skull is soft and pliable. Therefore, pressure
within the skull increases less in infants than it does in older children and
adults.
Chronic subdural hematomas are more difficult to diagnose because of the
length of time between the injury and the development of symptoms. An older
person with gradually developing symptoms, such as memory impairment and
drowsiness, may be mistakenly thought to have dementia. CT can detect acute,
subacute, and many chronic subdural hematomas. Magnetic resonance
imaging (MRI) is particularly accurate for diagnosis of chronic subdural
hematomas.
TREATMENT

Often, small subdural hematomas in adults do not require treatment because


the blood is absorbed on its own. If a subdural hematoma is large and is
causing symptoms such as persisting headache, fluctuating drowsiness,
confusion, memory changes, and paralysis on the opposite side of the body,
doctors usually drain it surgically, sometimes by drilling a small hole in the
skull. However, sometimes a larger opening must be made in the skull, for
example when bleeding has occurred very recently, when the blood may be too
thick to drain through a small hole. During surgery, a drain is usually inserted
and left in place for several days, because subdural hematomas can recur. The
person is monitored closely for recurrences. In infants, doctors usually drain
the hematoma for cosmetic if for no other reasons.
Only about 50% of people who are treated for a large acute subdural
hematoma survive. People who are treated for a chronic subdural hematoma
usually improve or do not worsen.
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