About Epidural Hematomas

Information about Epidural Hematoma (EDH)

General Information

An epidural hematoma (EDH) occurs when blood accumulates between the skull and the dura mater, the thick membrane covering the brain.

• They typically occur when a skull fracture tears an underlying blood vessel.
• EDHs are about half as common as a subdural hematomas and usually occur in young adults.
• They occur four times as often among males compared with females and rarely before age 2 or after age 60.

Symptoms

• Classic symptoms of EDH involve brief loss of consciousness followed by a period of awareness that may last several hours before brain function deteriorates, sometimes leaving the patient in a coma.
• If untreated, the condition can cause increased blood pressure, difficulty breathing, damage to brain function and death.
• Other symptoms include headache, vomiting and seizure.

Diagnosis

• Medical personnel typically use computed tomography (CT) brain scans to diagnose an EDH, which appears as a dense mass that pushes the brain away from the skull.
• A magnetic resonance imaging (MRI) scan can also diagnose an EDH, although CT is faster and more commonly used for evaluating trauma patients.

Treatment

• A small EDH with no pressure on the brain can be treated without surgery.
• Severe headache and deterioration of brain function, or an EDH larger than 1 cm at its thickest point, generally indicates surgery is necessary.
• Surgeons treat EDH by removing the clot to lower pressure on the brain and stopping bleeding to prevent the hematoma from returning.

Outcome

• Recovery after brain injury varies widely.
• The most important predictors of treatment outcome include the initial Glasgow Coma Scale (GCS) score, pupil response, a motor exam and associated brain injuries seen on the CT scan.
• In individuals who do not fall into a coma, a favorable outcome occurs in 90 percent to 100 percent of patients, while mortality ranges from 0 to 5 percent.
• For comatose patients (GCS 8 or less), a favorable outcome occurs in 38 percent to 73 percent with a mortality rate of 11 percent to 41 percent.
• Normal pupil response prior to surgery is associated with a favorable outcome in 84 percent to 100 percent of patients. When both pupils are dilated, however, a poor outcome or death occurs in the great majority of patients.
• Associated intracranial injuries such as cerebral contusions adversely affect outcome.
• Rapid diagnosis and urgent surgical treatment improve chances of recovery in patients with severe EDH.

The Neuro-ICU cares for patients with all types of neurosurgical and neurological injuries, including stroke, brain hemorrhage, trauma and tumors. We work in close cooperation with your surgeon or medical doctor with whom you have had initial contact. Together with the surgeon or medical doctor, the Neuro-ICU attending physician and team members direct your family member's care while in the ICU. The Neuro-ICU team consists of the bedside nurses, nurse practitioners, physicians in specialty training (Fellows) and attending physicians. UCLA Neuro ICU Family Guide