Epidural Hemorrhage: Symptoms, Causes, Diagnosis and Treatment

Written by Medicover Team and Medically Reviewed by Dr Krishna Haskar Dhanyamraju , Neurologists

Epidural Hemorrhage, also known as an epidural hematoma, is a medical emergency in which blood collects between the inner surface of the skull and the dura mater, the outer protective covering of the brain. It most commonly results from a head injury that tears an artery, especially the middle meningeal artery, often following a skull fracture. Symptoms may include severe headache, loss of consciousness, a temporary lucid interval, vomiting, confusion, drowsiness, seizures, weakness, or unequal pupils. Early diagnosis and immediate treatment, often involving emergency surgery, are essential to relieve pressure on the brain, prevent permanent neurological damage, and save life.

What are the Symptoms of Epidural Hemorrhage?

Recognizing the symptoms of an epidural hemorrhage is paramount for timely intervention. Patients often experience a "lucid interval" following the injury, where they regain consciousness and appear normal before rapidly deteriorating. This is a hallmark sign but not present in all cases.

Other symptoms include:

The presence of these symptoms necessitates immediate medical evaluation to prevent further complications.

What are the Causes of Epidural Hemorrhage?

Epidural hemorrhages are most commonly caused by head injuries that lead to the tearing of blood vessels, particularly the meningeal arteries. Such injuries can result from falls, vehicular accidents, sports-related incidents, or physical assaults. The impact causes blood to accumulate between the dura mater and the skull, creating pressure on the brain.

Risk Factors for Epidural Hemorrhage

Several risk factors increase the likelihood of developing an epidural hemorrhage. These include engaging in high-risk activities such as contact sports or motorcycling without proper protective gear. Individuals with clotting disorders or those on anticoagulant therapy also face a heightened risk, as even minor trauma can lead to significant bleeding.

Moreover, children and adolescents are more susceptible due to their relatively thinner cranial bones and higher propensity for head injuries during play or sports activities.

When to See a Doctor for Epidural Hemorrhage?

Anyone who experiences a significant head injury, especially with loss of consciousness, severe headache, vomiting, confusion, or neurological symptoms, should seek immediate evaluation by an Emergency Physician. A neurologists is often involved in treatment.

You should seek immediate medical care if you experience:

Call emergency medical services immediately if you:

These symptoms may indicate increasing pressure inside the skull and require emergency treatment to prevent permanent brain damage or death.

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How Is an Epidural Hemorrhage Diagnosed?

The diagnosis of epidural hemorrhage involves a thorough clinical assessment followed by neuroimaging techniques. Computed tomography (CT) scans are the gold standard for detecting epidural hemorrhages due to their ability to quickly visualize acute bleeding. CT scans typically reveal a biconvex (lens-shaped) hyperdense area, indicative of the hemorrhage.

In certain cases, magnetic resonance imaging (MRI) may be utilized to provide additional information, especially if the CT scan results are inconclusive or if there is a need to assess for underlying brain injuries.

What are the Treatment Options for Epidural Hemorrhage?

Prompt surgical intervention is often required to manage epidural hemorrhages effectively. The primary goal is to alleviate pressure on the brain by evacuating the hematoma. Treatment approaches include:

Craniotomy

A craniotomy involves creating an opening in the skull to access and remove the accumulated blood. This procedure is typically performed in cases of large hematomas or when there is significant neurological impairment.

Burr Hole Surgery

In less severe cases, burr hole surgery might be performed. This less invasive procedure involves drilling a small hole in the skull to drain the blood. It is generally reserved for smaller hematomas or when the patient is stable.

Non-Surgical Management

In select cases, particularly when the hemorrhage is small and the patient is neurologically stable, conservative management with close monitoring in an intensive care setting may be appropriate. This approach requires regular neuroimaging and neurological assessments to ensure that the condition does not worsen.

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What is the Recovery Process for Epidural Hemorrhage?

Recovery depends on the severity of the brain injury, the size of the hemorrhage, the speed of treatment, and the individual's overall health. Individuals who receive prompt treatment before significant brain damage often recover well, while severe cases may require prolonged rehabilitation. Regular neurological follow-up helps monitor recovery and detect long-term complications.

Attending follow-up appointments, participating in physical, occupational, or speech therapy when recommended, taking prescribed medications, avoiding activities that increase the risk of another head injury, maintaining a healthy lifestyle, and reporting any new neurological symptoms promptly help support long-term recovery.

Recovery Includes