Complications | Epidural bleeding

Complications

If the pressure is not relieved from the brain and the epidural bleeding continues to spread, life-threatening complications can arise. For example, the extreme space requirement can lead to the so-called constriction syndrome. There are two possible localizations.

In the upper incarceration, the temporal lobe is pressed under the tentorium cerebelli, which consists of the meninges. The cerebrum (telencephalon) is normally located on this tentorium. The shifting of the telencephalon leads to a squeezing of the diencephalon, which controls vital processes.

Impairment of this can lead to the death of the patient. In addition, nerve tracts run nearby, which control the movement of the body and, if impaired, cause paralysis. The lower incarceration is equally dangerous.

Here, pressure from above pushes the cerebellum (cerebelli) into the foramen magnum, which is located on the underside of the skull bone. This connects the brain, more precisely the medulla oblongata, with the spinal cord. Like the diencephalon, the brain stem contains vital control centers of the body, such as the respiratory center. If the medulla oblongata is compressed by the cerebellum, the patient will stop breathing and eventually die.

Diagnostics

There are actually only two diagnostic options available to the treating physician. He can interpret the clinical symptoms correctly or use imaging techniques. Clinically, certain features specific to epidural bleeding are evident.

These include interval symptoms, with a symptom-free pause between the first fainting (syncope). The second phase can progress into a comatose state. Furthermore, an uneven pupil size (anisocoria), clouding of consciousness with attention deficit disorder and hemiplegia, i.e. a motor or sensory disorder on one half of the body, indicate epidural bleeding.

It is important to note that the symptoms are likely to worsen progressively as the hematoma gains volume and restricts brain function. In addition to these characteristics, a conspicuous finding during physical examination, especially in the reflex status, can provide indications of an existing injury. The imaging procedure of choice in cases of suspected epidural bleeding is computed tomography (CT).

Approximately 90% of hematomas can be confirmed by the CT image. The bleeding is bright (hyperdens = high density), sharply demarcated from the surrounding tissue and lenticular (biconvex) in width. The midline of the brain, which lies between the left and right hemisphere of the brain, is shifted to the healthy side, as the hematoma pushes the brain tissue away.

In most cases, the described phenomenon can be found in the area of the temporal and/or parietal lobe, i.e. on the side of the brain. In addition to a CT, magnetic resonance imaging (MRI) can also be helpful, in which the shape of the hematoma has the same characteristics. The method of first choice for suspected spinal epidural bleeding is an MRI. In addition, the coagulation values and the number of thrombocytes in the blood can be checked in order to investigate the origin of a depicted mass.